admin
Fri, 10/14/2022 - 16:56
Edited Text
Running Header: MAKING MUSIC WITH MOMMY AND ME
“Making Music with Mommy and Me”: A Perinatal Music Therapy Program
Alicia Drexel
Berklee College of Music
MAKING MUSIC WITH MOMMY AND ME
Abstract
Making Music with Mommy and Me is a perinatal music therapy program
designed for mothers who want to connect more with their infants. This program aims to
use the technique of songwriting and other music based bonding techniques to tap into
the creativity of the mother as a way for her to bond with her baby and form healthy
maternal-infant attachments. An accompanying guidebook provides music therapists
with a pre-questionnaire, assessment forms, a post-questionnaire, as well as session
outlines, a list of suggested songs, and options for songwriting. By the end of this threesession program, the mother will have learned techniques to bond with her baby, and
created a bonding song, which she can sing to her newborn baby.
Keywords: music therapy, postpartum depression, attachment, bonding, perinatal
2
MAKING MUSIC WITH MOMMY AND ME
3
Acknowledgments
I would like to thank everyone who helped shape this project. First to my amazing
chairperson, Dr. Suzanne Hanser, thank you for your unending support in first helping me
form my original ideas into this project and then for your guidance in developing the
guidebook and pushing me to articulate everything clearly. Thank you to Dr. Joy Allen,
and Heidi Lengel for coming aboard my committee and providing insight and knowledge
regarding this area of music therapy. To my family, thank you for all your love and
support as I went through this journey and for always believing in me.
I am grateful to have been a part of the second graduating class of the graduate
music therapy program at Berklee College of Music and to have been among many
inspiring music therapists. My experience has changed me as a music therapist, and I
will always be thankful for the connections I made.
Lastly, I acknowledge that I would not have been able to complete this without
the help from above. “I can do all things through Christ who strengthens me”
~Philippians 4:13. And that this was all part of His plan for me. “For I know the plans I
have for you, declares the Lord, plans to prosper you and not to harm you, plans to give
you a hope and a future” ~Jeremiah 29:11
MAKING MUSIC WITH MOMMY AND ME
4
Table of Contents
Abstract……………………………………………………………………………………2
Acknowledgments…………………………………………………………………………3
PART A: Background and Development of the Guidebook- Making Music with Mommy
and Me: A Perinatal Music Therapy Program ……………………………………………5
1. INTRODUCTION……………………………………………………………………...7
2. LITERATURE REVIEW………………………………………………………………8
2.1 Pregnancy Stressor and Postpartum Depression.……………………………...8
2.2 Attachment. …………………………………………………………………...9
2.3 Music and Pregnancy………………………………………………………...11
2.4 Music Therapy and Pregnancy……………………………………………….12
2.5 Music and Early Infant- Mommy and Me Programs ………………………..14
2.6 Rationale and Purpose………………………………………………………..15
3. METHODS……………………………………………………………………………15
3.1 Qualifications and Training.………………………………………………....16
3.2 Settings and Materials……………………………………………..................17
3.3 Session-by-session……………………………………………………...……17
3.4 Evaluation Tools……………………………………………………………..19
4. CONCLUSIONS AND RECOMMENDATIONS.…………………………………...21
5. REFERENCES………………………………………………………………………..23
PART B: Guidebook- Making Music with Mommy and Me: A Perinatal Music Therapy
Program…………………………………………………………………..……………... 28
MAKING MUSIC WITH MOMMY AND ME
PART A
Background and Development of The Guidebook- Making Music with
Mommy and Me: A Perinatal Music Therapy Program
5
MAKING MUSIC WITH MOMMY AND ME
6
Part A contains background information and details of the development of the
guidebook- Making Music with Mommy and Me: A Perinatal Music Therapy Program.
This program was developed to address a key area of development in neonate: attachment
and bonding. The introduction and literature review explain the need and importance of
the bond between a mother and infant, as well as the challenges that may arise during
pregnancy and postpartum that can hinder this process. A brief look at the current
research in music therapy, as well as current programs available for this population is
also discussed. An explanation of each part of the guidebook is described as well as the
selection of the bonding techniques.
The guidebook can be found in Part B - Making Music with Mommy and Me: A
Perinatal Music Therapy Program. The guidebook provides music therapists with a prequestionnaire, assessment forms, a post-questionnaire, as well as session outlines, list of
suggested songs, and options for songwriting. The guidebook also contains resources for
postpartum depression and details of the four bonding techniques that are implemented in
the three sessions.
MAKING MUSIC WITH MOMMY AND ME
7
Introduction
Music is universal! People of all ages and cultures can listen, perform, create and
enjoy music (Davis, Gfeller & Thaut, 2008). Music is multisensory: auditory, visual,
tactile and kinesthetic (Bruscia, 1998). Music is unique to humans and is part of the
culture and history. Music is both active and receptive in nature; composition,
improvisation, performance and listening each have significant roles (Bruscia, 1998).
Music is fundamental in bringing people together. Whether in a communal fashion with
many or in more intimate family gathering, music has had a role and impactful power to
bring people to bring people together for centuries (Davis, Gfeller & Thaut, 2008). It not
only brings people together but can also create relationships and bonds between people.
Forming these attachments is crucial for our survival as humans; we need to feel
connected and a part of something. It is a human need to develop close emotional bonds
as a biological function of survival (Bowlby, 2008). These relationships and attachments
begin early in our lives. It is therefore important for mother and baby to form healthy
attachments in order to promote growth and health in both baby and mother postpartum
or after birth. These healthy attachments are not only crucial during the perinatal stage of
pregnancy, but will impact the future relationship between baby and mother (Maddahi,
Dolatian, Khoramabadi & Talebi, 2016). Research supporting the challenges inherent
during pregnancy and during postpartum are presented here, along with findings
regarding the role of music in pregnancy and after the birth. As can be seen in the
literature, the universal, multisensory, unique phenomenon that is fundamental in
bringing people together may also aid and support this process of maternal-infant
attachments.
MAKING MUSIC WITH MOMMY AND ME
8
Literature Review
Pregnancy Stressors and Postpartum Depression
Both pregnancy and postpartum period can bring many challenges for baby and
mother. Pregnancy can be a stressful time in a woman’s life. Mothers may be
experiencing changes in emotional, physical and social aspects of life (Shin & Kim,
2011). These stressors can increase when the pregnancy becomes a high-risk pregnancy
or the mother experiences any form of trauma during pregnancy. In addition to “normal”
stressors, mothers may experience stress related to hospitalization, their risk status, and
concerns over the health of the baby (White et al., 2008; Shin & Kim, 2011).
The transition into parenthood can also be stressful and mothers and/or caregivers
may experience other challenges during this time. Mothers may experience anxiety and
depression during their pregnancy and this can continue postpartum as well. Postpartum
depression affects up to 1 in 7 women, according to the American Psychological
Association (Postpartum Depression, n.d.). The DSM-V recognized that anxiety and
depression may occur both during and after pregnancy and has revised the once called
major depressive disorder with postpartum onset to major depressive disorder with
perinatal onset (Wenzel & Kleiman, 2015). Postpartum anxiety and depression can take
on various forms including generalized anxiety, panic attacks, social anxiety, obsessions
and compulsions, and posttraumatic stress. While there are risk factors any mother may
experience these symptoms.
Other stressful life events can also cause postpartum depression. A study done by
Salm, Kanu, & Robb (2017) examined how SLE’s were related to postpartum depression.
They looked at three SLE’s: arguments with partner, trouble paying bills, and
MAKING MUSIC WITH MOMMY AND ME
9
separation/divorce. It was concluded that experience high stress significantly predicted
postpartum depression.
Postpartum depression not only affects the mother, but can have a lasting effect
on the child as well. Closa-Monasterolo et al. (2017) looked at the effect of postpartum
depression and current mental health problems of the mother on child behavior at eight
years. They concluded that maternal postpartum depression and current mental health
problems, separately and synergistically, increase children's psychological problems at
8 years. Postpartum depression is also associated with decreased infant bonding,
impaired child development, marital discord, suicide, and infanticide (Wilkinson,
Anderson, & Wheeler, 2016).
There are various pharmacologic and non-pharmacologic treatment methods for
postpartum depression. In 2007, Msri & Kendrick (2007) conducted a literature search
on the treatment modalities used in the treatment in postpartum depressions. They found
that women with perinatal depression and anxiety disorders require timely and efficient
management with a goal of providing symptom relief for the suffering mother while
simultaneously ensuring the baby's safety. They also stated that although knowledge in
the area of appropriate intervention is constantly evolving, rigorous and scientifically
sound research in the future is critical. The purpose of the guidebook in this document is
to provide mothers with a resource to work on improving their bonds with their babies,
addressing one of the issues common in postpartum depression.
Attachment
Attachment is defined as “a close emotional bond between two people” (Santrock,
2008, p.360). Many theorists have views on why infants become attached to their mother
MAKING MUSIC WITH MOMMY AND ME
10
or caregiver. For example, Freud notes that infant become attached to the person or
object that provides oral satisfaction, whereas Erikson believed physical comfort and
contact play a role in developing those attachments. Bowlby (2008), however, believed
that infants and their caregivers are predisposed to form attachments and that there are
four phases in developing the attachments. He believed that infants develop an internal
working model of attachment, a simple mental model of the caregiver, their relationship,
and the self as deserving of nurturing care (Bowlby, 2008).
Another set of theorists (Fonagy et al., 1995) believed in the theory of reflective
functioning (RF). Reflective functioning is the capacity to understand that one’s own or
another’s behaviors are linked in meaningful ways to underlying mental states such as
feelings, wishes, thoughts, and desires. Fonagy and colleagues suggested that secure
attachment is the direct outcome of successful containment, which is the parent’s ability
to reflect the infant’s internal state and represent that state for the infant as a manageable
experience. So not only does the mother have to understand the behavior demonstrated
by the infant, but she also must communicate that in a way that is a model for the infant.
Grienenberger, Kelly and Slade (2005) studied the correlation between mental states and
observed caregiver behavior in the intergenerational transmission of attachment. The
results of their study supported this theory of attachment, and further explained that
infants rely on their mothers to respond at the behavioral level relative to the mother’s
affective state.
Forming healthy attachments is crucial for infants and a necessary part of their
growth and development. It is both a physical and psychological need of babies that
provides comfort and protection. The mother is typically the first emotional attachment
MAKING MUSIC WITH MOMMY AND ME
11
of the child and therefore will have an impact on all future attachments the infant
develops (Perrelli, 2014). This bond, however, may not come naturally for the mothers,
but is an ongoing process starting during pregnancy and continuing once the infant is
born.
How can parents support this process? What can they do to promote healthy
attachments? Some studies have shown that singing lullabies to the infant promotes
maternal-infant bonding (Persico et al., 2017), while others focus on eye-to-eye contact
(Robson, 1975). The benefit of singing is that is can be done during pregnancy. Mothers
can sing to their babies and babies can begin to recognize their mother’s voice. A study
by Damastra-Wijmenga (1991) concluded that babies pay special attention to their
mother’s voices over other women’s voices and even to a lullaby, which the mother had
played for them. Babies begin to respond to sounds during the third trimmest of
development at about 32 weeks (Santrock, 2008). Therefore, these attachments can begin
during the beginning of the perinatal phase of pregnancy. While there are various
opinions on what the perinatal phase consists of, this protocol will be focusing on the
postpartum end of the spectrum and will include birth to one-year.
Music and Pregnancy
Music can have a role in reducing stressors associated with typical and high-risk
pregnancies. Active music making, listening to music and singing can reduce the stress
of the mother and therefore promote healthy development of the neonate (Arabin & Jahn,
2013). In addition to reducing the stressors, mothers are able to “interchange emotions
with their infants” (p 357), and increase the bond between them. While neonates will not
understand the meaning of words, they are able to comprehend elements of the music,
MAKING MUSIC WITH MOMMY AND ME
12
such as the musicality and rhythm of language, and begin to from a bond with the mother
and her voice.
Music Therapy and Pregnancy
Music therapy has also played a role in perinatal phases. It has been used to
promote relaxation during labor and delivery (Hanser, Larson & O’Connell, 1983; Clark,
McCorkle & Williams, 1981) and during transvaginal ultrasounds (Shin & Kim, 2011)
and has addressed areas, such as alleviating stress during antepartum hospitalization
(Bauer et al., 2010) and the psychological health of women during pregnancy (Mei-Yuah,
Chung-Hey & Kuo-Feng, 2008). However, there is little research on the effects of music
therapy in regard to maternal-fetal attachment. Chang, Chen & Chen (2015), recommend
further study investigating the long-term effect of listening to music on childbirth
outcomes and postnatal psychology of women.
Music therapy has also played a role during the postpartum phase. Researchers
such as Jayne Standley and Joanne Loewy have both pioneered various techniques and
interventions for use of music therapy with premature infants. In her book, “Music
Therapy with Premature Infants” (2010), Standley describes three techniques to be used
in the NICU. They include sustained live music, music and non-nutritive sucking (NNS)
and music and multimodal stimulation. While all of these techniques require the
implementation by a NICU trained music therapist, the multimodal stimulation can be
done with the parent facilitated by the music therapist. Joanne Loewy pioneered another
music therapy training called First Sounds RBL (rhythm, breath, lullaby). Through this
intensive training music therapist learn various techniques to be implemented in the
NICU, which emphasizes on healthy dyadic or triadic relationships, trauma amelioration,
MAKING MUSIC WITH MOMMY AND ME
13
and neuropsychological development (“The development of,” n.d.). The focus in both of
these NICU training is primarily on the hospitalized infant, while both do include the
mother or caregivers, the emphasis is on infant outcomes and typically takes place in the
hospital.
Joanne Loewy also edited a book titled “Music Therapy in the Neonatal Intensive
Care Unit” (2000) in which chapters inform readers of the current research and clinical
practice of music therapy in the NICU. Areas of content include how to institute a NICU
Music therapy program, the effects on feeding, research on infant-directed singing and
clinical techniques using both live and taped music in the treatment of neonates and their
families. Another resource edited by Jane Edwards is, “Music therapy and parent infant
bonding” (2011). This book includes three sections: (i) music therapy research and
practice to ameliorate vulnerability in infancy; (ii) descriptions of successful group music
therapy programs; and (iii) music therapy work with parents and infants in medical
settings (Edwards, 2011). As stated in the introduction, “this text aims to fill a much
needed gap to provide further support for teaching, practice and ongoing evaluation of
parent-infant bonding in music therapy; ultimately presenting a greater awareness of the
need for funded research that can inform policy and practice” (Edwards, 2011).
There is little music therapy literature focusing on the mothers during postpartum
period. One study done by Keith, Weaver, Vogel (2012) focused on the effect of musicbased listening interventions on the volume, fat content and caloric content of breast
milk. The results of this study showed that mothers in the experimental group produced
significantly more milk with significantly more fat content. Another study, non-music
therapy related, done by Norouzi, SeyedFatemi, and Montazeri (2013) focused on the
MAKING MUSIC WITH MOMMY AND ME
14
implementation of music during kangaroo care. The results of this study showed there
was evidence that kangaroo care had an effect on the severity of maternal anxiety state
but there was no significant difference when music was implemented. This investigation
suggested a need for more research to document the effectiveness of selected or familiar
music during kangaroo care on state anxiety in early postpartum.
The current project focuses on the development of a music therapy program
aimed to promote maternal-infant attachments. The primary music therapy intervention
is songwriting. This is a technique used in music therapy for many purposes. In some
cases, the therapist is writing an original composition to use in therapy; in others, the
patient/client is involved in the songwriting experience as therapy (Baker & Wigram,
2005). The Mommy and Me program presented here aims to use techniques, including
songwriting, and tap into the creativity of mothers as a way for them to bond with their
babies and form healthy maternal-infant attachments. Other bonding techniques, such as
auditory stimulation, jingles for everyday task, singing songs of kin and multimodal
stimulation, will also be introduced, and are explain further in the session-by-session plan
section found in Part B.
Music and Early Infant- Mommy and Me Programs
There are various Mommy and Me music programs that exist. Some include:
Music Together (Music Together, 2018), Sprouting Melodies (Sprouting Melodies,
2018), and Programs at Carnegie Hall such as The Lullaby Program (Carnegie Hall
Education, 2018). Music Together is an early childhood music and movement program
for children from birth through age eight and mothers, father, grandparents, nannies, etc.
They value the concept that children learn best from the role models in their lives, which
MAKING MUSIC WITH MOMMY AND ME
15
is why those individuals are a part of the groups. Classes are offered all over the country
at various locations through trained Music Together teachers. The program contains nine
different collections that contain a mix of original and traditional tunes (Music Together,
2018).
Sprouting Melodies is another early childhood music program developed by
music therapist and offers a development-based approach to infant and toddler music
classes. These groups are offered through music therapists who have completed the
Raising Harmony Early Childhood Training Program. Age-specific classes for infants,
toddlers, siblings and preschoolers include experiences that encourage musical, social,
physical, and emotional growth (Sprouting Melodies, 2018).
The Lullaby Project at Carnegie Hall pairs pregnant women and new mothers
with professional artists to write and sing personal lullabies for their babies. This
program recently released a CD with some of the original lullabies titled Hopes &
Dreams (Carnegie Hall Education, 2018).
Making Music with Mommy and Me: A Perinatal Music Therapy Program
incorporates ideas and principles from each of these programs. It is designed and should
be implemented by a music therapist; it is aimed to work with mothers and their infants;
and it includes the songwriting as the primary medium to promote bonding between the
mother and infant.
Rationale and Purpose
There is little music therapy literature on the use of songwriting within perinatal
populations. So it appears that a protocol needs to be created and tested in order to serve
this sensitive population. The aim of the suggested music therapy protocol in this project
MAKING MUSIC WITH MOMMY AND ME
16
is to provide new mothers the opportunity to use therapeutic songwriting as a way to
form healthy attachments with their neonate. Outcomes may include: positive effects on
neonate and maternal stress, lowered maternal anxiety, and promotion of social
development in the neonate. In a second phase beyond the scope of the author’s
culminating project, this perinatal music therapy protocol would be implemented and
evaluated. This would contribute to evidence on the impact of music therapy after the
birth of the baby, specifically in building maternal-infant attachments to promote health
and growth in the neonates and mothers post-pregnancy.
The protocol appears as a guidebook in Part B of this document. It describes
objectives and session plans for a perinatal music therapy program to build maternalinfant attachment in new mothers.
Methods
The guidebook was designed for individual music therapy sessions, as this
process is an intimate experience shared between the mother and baby, facilitated by the
music therapist. This guidebook focuses on the creation of a bonding song, which aims
to increase maternal-infant attachment, and promote bonding between the mother and
neonate. Target recipients include: (1) mothers over 18 years of age; (2) mothers in the
postpartum period of pregnancy, post birth to one year; and (3) mothers without hearing
impairment (based on self-report).
Qualifications and Training
Music therapists who have completed a degree program in music therapy and
passed the music therapy board exam administered by the Certification Board for Music
Therapist are qualified to implement this guidebook. Specialized training in NICU music
MAKING MUSIC WITH MOMMY AND ME
17
therapy is recommended, but not required. It is also recommended that the therapist have
additional training in the area of perinatal music therapy. The author may consider
developing a training program for music therapists to implement this guidebook in the
future.
Setting and materials
This program would be implemented in a quiet space where the music therapist
can meet with the mother, if feasible in the mother’s home. Mothers would be invited to
bring their babies along to the sessions. Required materials include: instruments of the
mother’s choice e.g., guitar, piano/keyboard, ocean drum, etc., which will be provided by
the music therapist; and recording device provided by therapist. Each session description
page contains a list of equipment/materials needed for that session (see Part B).
Session-by-session plan
A detailed set of session plans is articulated in the guidebook. These include
specific instructions for the music therapist to conduct a preliminary meeting, musicmaking and songwriting guidelines, and the recording of a bonding song. The protocol is
for three sessions that last approximately 60 minutes each. For each session, there is a
description page, including goals/objectives, equipment/materials required, procedure and
take-home tips.
During the preliminary meeting, the therapist explains the songwriting process
and the purpose of the intervention. The therapist explains that this is a three-session
program. During each session, the mother is given various bonding techniques to use
with her baby. She also creates her own bonding song with the music therapist. At the
end of each session, there will be take-home tips that are mini tasks for the mother to try
MAKING MUSIC WITH MOMMY AND ME
18
during the week before the next session. These techniques and the bonding song are
ways to promote healthy attachments and improve bonding with her baby. The therapist
also explains that it is necessary for the baby to be present so the music therapist can
demonstrate the various techniques during each session. The therapist also administers
the pre-questionnaire, Maternal Infant Bonding Scale and Postnatal Bonding
Questionnaire (see Evaluation Tools below).
Sessions thereafter include music making, such as singing of familiar songs and
songs of kin, and eventually, the creation of a bonding song. The therapist supports the
mother as much as needed in this process. The music therapist provides templates,
formats and options for creating a bonding song. Those include: lyric substitution, song
recreation, original songwriting done by mother and therapist, or original songwriting
done by the therapist. A recording of their special bonding song is provided for the
mother to use. She will be encouraged to sing this song to the baby when she wishes to
soothe the baby or herself.
Other bonding techniques will also be introduced throughout the three sessions.
These include auditory stimulation (Nocker-Ribaupierre, 2013), singing mother’s song of
kin (Loewy, 2000), jingles for everyday tasks (Hanser, 2016), and multimodal
stimulation (Standley, 2010). Auditory stimulation encourages the mother to speak to her
baby, using her voice as a way of telling her baby she is there and that she loves him/her.
The mother may choose to read a book, poem or verse to her baby, and will be
encouraged to create a jingle that includes an intention for her baby. Singing mother’s
songs of kin encourages the mother to sing her own favorite music to her baby, and the
therapist shows her ways to change and alter the song to be more appropriate to sing to an
MAKING MUSIC WITH MOMMY AND ME
19
infant. These can include changing the tempo, time signature, volume and articulation.
Jingles for everyday tasks encourages mother to create little jingles for everyday tasks,
such as changing the diaper and clothing, feeding, washing and playing. The mother is
asked to create her own jingles for each of these tasks. The multimodal stimulation
encourages the use of singing with massage and rocking. There is a progression for the
massage that is listed in the guidebook. These techniques developed by Standley and
Lowey for use in the NICU have been adapted to use in this guidebook. The focus of the
techniques in the guidebook is teaching the mother how to implement these techniques
normally done by a music therapist.
Evaluation tools
The following evaluation tools are administered to inform the music therapist, and
to determine whether any changes have occurred over the course of the program.
Pre-Questionnaire
This form gathers basic information from the mother and including background
information on the mother, the mother’s music background and expectations from this
program. It is to be filled out during the preliminary session and used during the
remaining sessions as a reference.
Mother-Infant Bonding Scale
The MIBS consists of eight adjectives divided into three aspects: positive,
negative and confused attachment. High scores indicate problems in the mother-infant
bonding (Perrelli, 2014). This scale is used as a pretest and posttest to evaluate changes
in mother-infant bonding.
Postpartum Bonding Questionnaire (PBQ)
MAKING MUSIC WITH MOMMY AND ME
20
The PBQ, a 25-ietm self-report questionnaire, aims to identify problems in the
mother-baby relationship based on four components: 1) weakened bonding; 2) rejection
and pathological rage; 3) anxiety about the baby/anxiety about caring for the baby; and 4)
imminent abuse/risk of abuse (Brokington et al., 2001). This scale is also be used as a
pretest and posttest to assess changes in mother-infant bonding.
Post-Questionnaire
This form is filled out after completion of the program and the recording of the
bonding song. It contains five wrap-up questions evaluating the mother’s experience
with the program. It is completed at the end of the third session.
MAKING MUSIC WITH MOMMY AND ME
21
Conclusions and Recommendations
After fully understanding postpartum depression and all the effects it can have on
not only the mother, but baby and family, it is clear that music therapy may have a role in
addressing those need areas. This protocol and resulting guidebook in Part B of this
document focuses on infant bonding and aims to not only promote maternal-infant
bonding, but also provide the mother with concrete tools that she can implement in her
everyday life to enhance those bonds. The techniques that are used in the guidebook
come from a variety of sources. These techniques are typically used in the medical
setting focusing on the baby; however, this protocol’s main focus is on the mother. How
can we empower the mother to have these tools to bond with her baby?
Making Music with Mommy and Me addresses this important aspect of maternalinfant bonding. This program is aimed to provide mothers with a tool to increase
bonding with their baby. These techniques are meant to be tangible tips on various ways
to implement music into the mother’s and baby’s life to promote bonding.
While the guidebook provides the music therapist with a resource to implement
this program with mothers, this protocol can be adapted to use with fathers, grandparents,
aunts, uncles, older siblings, or anyone who is looking to build a bond and relationship
with this new life that has entered the world. The layout and session outlines are very
structured; however, these techniques and tools may be implemented differently,
depending on the therapist’s intention. If it is not feasible to do the complete program,
the therapist can use and teach the mother one or a few techniques for the purpose of
promoting bonding.
MAKING MUSIC WITH MOMMY AND ME
Other considerations for the future would be the creation of a parent handbook
including these techniques to be given to mothers as a resource, after completing the
program. The next phase would be to pilot this program to study its effectiveness and
validate its outcomes.
22
MAKING MUSIC WITH MOMMY AND ME
23
References
Arabin, B., & Jahn, M. (2013). Need for interventional studies on the impact of music in
the perinatal period: results of a pilot study on women's preferences and review of
the literature. The Journal of Maternal-Fetal & Neonatal Medicine, 26(4), 357362.
Baker, F., & Wigram, T. (2005). Songwriting: methods, techniques and clinical
applications for music therapy clinicians, educators and students. Philadelphia,
PA: Jessica Kingsley Publishers.
Bauer, C. L., Victorson, D., Rosenbloom, S., Barocas, J., & Silver, R. K. (2010).
Alleviating distress during antepartum hospitalization: A randomized controlled
trial of music and recreation therapy. Journal of Women's Health 19(3), 523-531.
Bowlby, J. (2008). Attachment. New York, NY: Basic books.
Brockington, I. F., Oates, J., George, S., Turner, D., Vostanis, P., Sullivan, M., & ...
Murdoch, C. (2001). A screening questionnaire for mother-infant bonding
disorders. Archives Of Women's Mental Health, 3(4), 133-140.
Bruscia, K. E. (1998). Defining music therapy. Gilsum, NH: Barcelona Publishers
Carnegie Hall Education. (2018). Lullaby project. Retrieved 2018, May 23 from
https://www.carnegiehall.org/Education/Social-Impact/Lullaby-Project
Chang, H., Yu, C., Chen, S., & Chen, C. (2015). The effects of music listening on
psychosocial stress and maternal-fetal attachment during
pregnancy. Complementary Therapies in Medicine, 23(4), 509-515.
Clark, M. E., McCorkle, R. R., & Williams, S. B. (1981). Music therapy-assisted labor
and delivery. Journal of Music Therapy, 18(2), 88-100.
MAKING MUSIC WITH MOMMY AND ME
24
Closa-Monasterolo, R., Gispert-Llaurado, M., Canals, J., Luque, V., Zaragoza-Jordana,
M., Koletzko, B., & … Escribano Subias, J. (2017). The effect of postpartum
depression and current mental health problems of the mother on child behavior of
eight years. Maternal And Child Health Journal, 21(7), 1563-1572.
Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh
Postnatal Depression Scale (EPDS). London, England: Royal College of
Psychiatrists
Damstra-Wijmenga, S. M. (1991). The memory of the new-born baby. Midwives
Chronicle, 104(1238), 66-69
Davis, W. B., Gfeller, K. E., & Thaut, M. H. (2008). An introduction to music therapy
theory and practice. Silver Spring, Maryland: American Music Therapy
Association, Inc.
Edwards, J. (2011). Music therapy and parent infant bonding. New York, NY: Oxford
University Press.
Fonagy, P., Steele, M., Steele, H., Leigh, T., Kennedy, R., Mattoon, G., et al. (1995).
Attachment, the reflective self, and borderline states: The predictive specificity of
the Adult Attachment Interview and pathological emotional development. In S.
Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental
and clinical perspectives (pp. 233 – 278). Hillsdale, NJ: The Analytic Press.
Grienenberger, J. F., Kelly, K., & Slade, A. (2005). Maternal reflective functioning,
mother-infant affective communication, and infant attachment: exploring the link
between mental states and observed caregiving behavior in the intergenerational
transmission of attachment. Attachment & Human Development, 7(3), 299-311.
MAKING MUSIC WITH MOMMY AND ME
25
Hanser, S. B., Larson, S. C., & O'Connell, A. S. (1983). The effect of music on
relaxation of expectant mothers during labor. Journal of Music Therapy, 20(2),
50-58.
Hanser, S. B. (2016). Integrative health through music therapy accompanying the
journey from illness to wellness. United Kingdom: Palgrave Macmillan.
Keith, D. R., Weaver, B. S., Vogel, R. L. (2012). The effect of music-based listening
interventions on the volume, fat content, and caloric content of breast milk–
produced by mothers of premature and critically ill infants. Advances in Neonatal
Care, 12(2) 112-119.
Loewy, J. (2000) Music therapy in neonatal care unit. New York, NY: Satchnote Press
Maddahi, M. S., Dolatian, M., Khoramabadi, M., & Talebi, A. (2016). Correlation of
maternal-fetal attachment and health practices during pregnancy with neonatal
outcomes. Electronic Physician, 8(7), 2639-2644.
Mei-Yueh, C., Chung-Hey, C., & Kuo-Feng, H. (2008). Effects of music therapy on
psychological health of women during pregnancy. Journal of Clinical
Nursing, 17(19), 2580-2587.
Misri, S & Kendrick, K. (2007). Treatment of perinatal moddo and anxiety diorders: a
review. Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie,
52(8), 489-498.
Music Together. (2018). What is music together? Retrieved 2018, May 24 from
https://www.musictogether.com/about
NICU music therapy. The development of rhythm, breathe, & lullaby in clinical practice.
MAKING MUSIC WITH MOMMY AND ME
26
(n.d). Retrieved from
http://nicumusictherapy.com/Nicumusictherapy/Training.html
Nocker-Ribaupierre, M.(2013). Premature infants. In Bradt, J. (Ed.), Guidelines for
music therapy practice in pediatric care (66-115). Gilsum, NH: Barcelona
Publishers
Norouzi, F., Keshavarz, M., SeyedFatemi, N., & Montazeri, A. (2013). The impact of
kangaroo care and music on maternal state anxiety. Complementary Therapies In
Medicine, 21(5), 468-472.
Perrelli, J. A., Zambaldi, C.F., Cantilino, A., & Sougey, E. B. (2014). Mother-child
bonding assessment tools. Revista Paulista De Pediatria: Orgao Oficial Da
Sociedade De Pediatria De Sao Paulo, 32(3), 257-265.
Persico, G., Antolini, L., Vergani, P., Costantini, W., Nardi, M. T., & Bellotti, L. (2017).
Maternal singing of lullabies during pregnancy and after birth: Effects on
mother-infant bonding and on newborns’ behavior. Concurrent Cohort Study.
Women and Birth: Journal of The Australian College of Midwives, 30(4).
Postpartum Depression. (n.d.) In American Psychological Association online. Retrieved
from
http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx
Robson, K.S. (1975). The role of eye-to-eye contact in maternal-infant attachment.
Journal of Child Psychology, Psychiatry and Allied Disciplines, 8(1), 13-25
Salm, Ward, T., Kanu, F. A., & Robb, S. W. (2017). Prevalence of stressful life events
during pregnancy and its association with postpartum depressive symptoms.
Archives Of Women’s Mental Health, 20(1), 161-171
MAKING MUSIC WITH MOMMY AND ME
27
Santrock, J., W. (2008). A topical approach to life-span development. New York, New
York: MGraw-Hill.
Shin, H. S., & Kim, J. H. (2011). Music therapy on anxiety, stress and maternal-fetal
attachment in pregnant women during transvaginal ultrasound. Asian Nursing
Research, 5(1), 19-27.
Sprouting Melodies. (2018). Programs and Classes. Retrieved 2018, May 23 from
http://sproutingmelodies.com/programs-classes/
Standley, J. M., Walworth, D. (2010). Music therapy with premature infants. Silver
Spring, Maryland: American Music Therapy Association, Inc.
Wenzel, A., Kleiman, K., (2015). Cognitive behavioral therapy for perinatal distress.
New York, New York: Routledge Taylor and Francis Group.
White, O., McCorry, N. K., Scott-Heyes, G., Dempster, M., & Manderson, J. (2008).
Maternal appraisals of risk, coping and prenatal attachment among women
hospitalised with pregnancy complications. Journal of Reproductive & Infant
Psychology, 26(2), 74-85.
Wilkinson, A., Anderson, S., & Wheeler, S. B. (2017). Screening for and treatment
postpartum depression and psychosis: a cost-effectiveness analysis. Maternal And
Child Health Journal, 21(4), 903-914.
MAKING MUSIC WITH MOMMY AND ME
PART B
The Guidebook- Making Music with Mommy and Me: A Perinatal
Music Therapy Program
28
Making Music with Mommy and Me
ð
A PERINATAL MUSIC THERAPY PROGRAM
GUIDEBOOK
ALICIA DREXEL, MT-BC
BERKLEE COLLEGE OF MUSIC
MAY 2018
Making Music with Mommy and Me
A Perinatal Music Therapy Program
CONTENTS
Introduction ……………………………………………………………………………...3
Maternal-Infant Attachment ……………………………………………………...3
Bonding Techniques ……………………………………………………………...3
Evaluation Tools ………………………………………………………………….4
Suggestions and Considerations ………………………………………………….5
Qualifications and Training….……………………………………………………5
Session Outline Description Page.………………………………………………..6
Session Outlines
Preliminary Session ………………………………………………………………7
Session 1: Music-making..………………………………………………………..8
Session 2: Creation of bonding song.…………………………………………....10
Session 3: Completion of bonding song.………………………………………...12
Bonding Techniques.…………………………………………………………………...14
Technique 1: Auditory Stimulation
Technique 2: Singing mother’s song of kin
Technique 3: Jingles for everyday tasks
Technique 4: Multimodal Stimulation Instructions…..………………………….15
Options for Songwriting.……………………………………………………………….17
Steps.…………………………………………………………………………….18
List of Suggested Songs………………………………………………………………...20
Evaluation Tools
A: Pre-Questionnaire.…..………………………………………………………..21
B: Maternal-Infant Bonding Scale (MIBS)…………...…………………………23
C: Postpartum Bonding Questionnaire (PBQ).………..………………………...25
D: Post-Questionnaire.……………………..……………………………………26
Postpartum Depression Information.…………………………………………………...28
Postpartum Depression Resources……………………………………………………...29
Edinburgh Postnatal Depression Scale (EPDS)………………………………………...30
Music Therapy Resources………………………………………………………………32
Guidebook References …………………………………………………………………33
2
Making Music with Mommy and Me
A Perinatal Music Therapy Program
INTRODUCTION
Making Music with Mommy and Me is a perinatal music therapy program designed for mothers who
want to connect more with their infants. This program aims to use the technique of songwriting and
taps into the creativity of the mother as a way for her to bond with her baby and form healthy maternalinfant attachments. This guidebook provides music therapists with a pre-questionnaire, assessment
forms, a post-questionnaire, as well as session outlines, list of suggested songs, and options for
songwriting. The session outlines contain a description page for each of the three sessions. For each
session, there are goals/objectives, equipment/materials required, procedure and take-home tips. The
mother will be encouraged to engage with her baby throughout the sessions and will be given various
techniques on ways to bond with her baby. She will be asked to sing and make music with the baby
and therapist. By the end of this three-session program, the mother will have learned techniques to
bond with her baby, and created a bonding song, which she can sing to her newborn baby.
Maternal-Infant Attachments
Attachment is defined as “a close emotional bond between two people” (Santrock, 2008,
p.360). Forming healthy attachments is crucial for infants and a necessary part of their growth and
development. It is both a physical and psychological need of babies that provides comfort and
protection. The mother is typically the first emotional attachment for the child and therefore, will have
an impact on all future attachments the infant develops (Perrelli, 2014). This bond, however, may not
come naturally for the mothers, but is an ongoing process starting during pregnancy and continuing
once the infant is born.
Bonding Techniques
One of the interventions used in this program is the creation of a bonding song through
songwriting. There are four options for creating a bonding song. Those include: lyric substitution,
song recreation, original song writing done by mother and therapist, or original songwriting done by
the therapist. A recording of the special bonding song will be provided for the mother to use and she
will be encouraged to sing this song to the baby, when she wishes to soothe the baby or herself.
3
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Other bonding techniques will also be introduced throughout the three sessions. These include
auditory stimulation (Nocker-Ribaupierre, 2013), singing mother’s song of kin (Loewy, 2000), jingles
for everyday tasks (Hanser, 2016), and a multimodal stimulation technique (Standley, 2010). Auditory
stimulation encourages the mother to speak to her baby, using her voice as a way of telling her baby
she is there and that she loves him/her. The mother may choose to read a book, poem or verse to her
baby, and will be encouraged to create a jingle that provides an intention for her baby. Singing
mother’s songs of kin encourages the mother to sing her own favorite music to her baby, and the
therapist shows her ways to change and alter the song, to be more appropriate to sing to an infant.
These can include changing the tempo, time signature, volume and articulation. Jingles for everyday
tasks include short, affirmative tunes for everyday tasks, such as changing the diaper and clothing,
feeding, washing and playing. The mother will be asked to create her own jingles for each of these
tasks. The multimodal stimulation technique encourages the use of singing with massage and rocking.
There is a progression for the massage that is listed in the guidebook. These techniques developed by
Standley and Loewy that have been used in the NICU and have been adapted to use in this guidebook.
The focus of the techniques in the guidebook is teaching the mother how to implement these
techniques normally done by a music therapist. A description of each technique can be found on page
14 of the guidebook.
Evaluation Tools
The following post- and pre-tests will be administered. These forms can be found in the appendix of
the guidebook.
Pre-Questionnaire
This form will gather basic information from the mother, including background information on
the mother, the mother’s music background and expectations from this program. It will be filled out
during the preliminary session and used during the remaining sessions as a reference.
Mother-Infant Bonding Scale (MIBS)
The MIBS consists of eight adjectives divided into three aspects: positive, negative and
confused attachment. High scores indicate problems in the mother-infant bonding (Perrelli, 2014).
This scale is used as a pretest and posttest to evaluate changes in mother-infant bonding
4
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Postpartum Bonding Questionnaire (PBQ)
The PBQ, a 25-ietm self-report questionnaire, aims to identify problems in the mother-baby
relationship based on four components: 1) weakened bonding, 2) rejection and pathological rage, 3)
anxiety about the baby/anxiety about caring for the baby, and 4) imminent abuse/risk of abuse
(Brokington et al., 2001). This scale will also be used as a pretest and posttest to assess mother-infant
bonding.
Post-Questionnaire
This form will be filled out after completion of the program and recording of the bonding song.
It contains five wrap-up questions evaluating the mother’s experience with the program. It will be
completed at the end of the third session.
Suggestions and Considerations
The guidebook is designed for individual music therapy sessions, as this process is an intimate
experience shared between the mother and baby, facilitated by the music therapist. This program
should be implemented in a quiet space where the music therapist can meet with the mother. The
mother will be invited and encouraged to bring her baby along to the sessions.
This guidebook may also be adapted and used with other caregivers including fathers,
grandparents, older siblings, and any other caregiver. The author does, however, stress the importance
of the maternal-infant relationship, as explained in the introduction.
Qualifications and Training
A music therapist, who has completed a degree program in music therapy and passed the music
therapy board exam administered by the Certification Board for Music Therapists, is qualified to
implement this guidebook. Specialized training in NICU music therapy is recommended, but not
required. It is also recommended that the therapist have additional training in the area of perinatal
music therapy and those without should seek supervision from an experienced board certified music
therapist. A list of books and resources if found at the end of this guidebook (page 32).
5
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session Outline Description Page
Goals/objectives
Each session has goals/objectives. The statements all begin with “Mother will…” and provide the
therapist with a clear idea of the purpose of the session. There is a preliminary session followed by
session 1: music-making, session 2: creation of bonding song and session 3: completion of bonding
song.
Equipment/materials
The required equipment and materials will be listed. Items will include the forms, instruments, and
recording equipment. All forms can be found in the appendix.
Procedure
This section contains a list of steps to take in each session, including bonding techniques for the
mother to engage with her baby. The section is presented in a step-by-step fashion; however it does
not need to be completed in the numerical order presented on the description page.
Take-home tips
This section includes suggested tasks for the mother to complete during the week to foster bonding
with her baby. The therapist will guide the mother during the session and then ask the mother to try
these on her own. At the beginning of the next session, these will be addressed and checked to see
how the mother has implemented the take-home tips that week.
6
Making Music with Mommy and Me
A Perinatal Music Therapy Program
SESSION OUTLINES
Preliminary Session
Goals/objectives
Mother will understand the songwriting process and purpose for the intervention
Mother will complete the pre-questionnaire, MIBS and PBQ
Mother will be introduced to the options for songwriting
Equipment/materials
Pre-Questionnaire (evaluation form A)
MIBS (evaluation form B)
PBQ form (evaluation form C)
Procedure:
1. Explain that this is a three-session program and during each session, the mother will be given
various bonding techniques to use with her baby. She will also be creating her own bonding
song with the music therapist. At the end of each session, there will be take-home tips that are
mini-tasks for the mother to try during the week before the next session. These techniques and
the bonding song are ways to promote healthy attachments and improve bonding with her baby.
Explain that it is necessary for the baby to be present so the music therapist can demonstrate the
various techniques during each session.
2. Allow mother to fill out each form (pre-questionnaire, MIBS and PBQ) and collect assessments
for scoring. See evaluation forms for scoring of each assessment form.
3. Provide mother with the options for songwriting and explain each option, giving her an
overview of what is to come.
4. Answer any questions she may have, and make a plan for future sessions (when & where).
7
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session 1: Music-making
Goals/objectives:
Mother will explore her music interests and be shown how she can present those to her baby
Mother will learn two techniques to engage with her baby
Mother will choose the option for songwriting
Equipment/materials
Completed forms
Pre-Questionnaire (for reference)
Music for songs/bands/genres mother indicated on her intake form
Guitar for live music and/or device to play recorded music
Procedure
1. Begin by encouraging the mother to hold her baby and talk to him/her. Explain that the
mother’s voice is the most familiar sound to the baby and encourage this interaction by
developing some mantras (examples can be found in the Take-Home Tips section).
2. Discuss answers on Pre-Questionnaire, focusing on the Music Background section. When
discussing mother’s preferred music, sing one of her favorite songs. If the mother or therapist
is uncertain of the words, show the mother where she can find them, and then sing the song
together. Discuss the meaning and/or significance this song has for the mother.
3. Encourage the mother to sing this song to her baby. This song has great meaning for the
mother and she should feel comfortable with sharing this part of her with her baby. Together
think of ways that the song could be adapted to sing to her baby: slowing down the tempo or
elongating the phrases; changing the time signature to 3/4; changing the dynamics or
articulation. Remind mother that babies are sensitive to new stimulation, but encourage them
to use her own voice to talk and sing to her baby. Her baby could hear her voice already while
in the womb and therefore is the most familiar sound he/she knows.
4. At the conclusion of the session, review the options for songwriting and have the mother decide
which one she would like to work on during the next session.
8
Making Music with Mommy and Me
A Perinatal Music Therapy Program
5. End the session by providing the mother with the Take-Home Tips.
Take-Home Tips
1. Encourage mother to sing her favorite song to her baby throughout the week and ask her to find
a lullaby that she could also sing to her baby
2. Ask mother to write down a jingle as an affirmative intention for her baby. Examples of a
mantra include: “I love you” “You are my everything”
9
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session 2: Creation of bonding song
Goals/objectives
Mother will learn two new techniques to engage with her baby
Mother will develop the bonding song
Equipment/materials
Guitar for live music and/or device to play recorded music
Notepad or recording device to use during song writing process
Print out of the Multimodal Stimulation Technique
Procedure
1. Begin the session by reviewing the Take-Home Tips from session 1 and check-in to see how
they went. Review the two techniques from session 1 and have the mother sing her favorite
song to her baby. Ask the mother what jingles she created and encourage her to sing/say these
to her baby.
2. Discuss different times she can sing to her baby, for example when changing the diaper and
clothing, when feeding, when washing and when playing. Create little jingles for each of these
tasks and any other tasks the mother suggests.
3. Demonstrate to the mother how touch can have a positive effect on the baby too. Multimodal
stimulation can help the baby tolerate and process different kinds of stimulation. This
stimulation begins with singing and then goes through massaging different parts of the baby’s
body. Steps for this technique can be found on the Multimodal Stimulation Instructions page
(page 15). Encourage the mother to try this process during the session and point out moments
of over stimulation. Provide the mother with a handout of the instruction page for her to try at
home.
4. Review the option the mother selected for songwriting. Begin the steps listed on pages 18-19.
5. End the session by reflecting on the songwriting process, and provide the mother with the
Take-Home Tips.
10
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Take-Home Tips
1. Encourage mother to use the jingles created
2. Provide the mother with a handout of the Multimodal Stimulation techniques and ask her to try
them at home
3. Encourage mother to sing part of the bonding song that was created during session 2 to her
baby throughout the week
11
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session 3: Completion of bonding song
Goals/objectives
Mother will complete the bonding song
Mother will create art for cover of CD
Mother will complete Post-Questionnaire, MIBS, and PBQ
Equipment/materials
Post-Questionnaire (evaluation form D)
MIBS (evaluation form B)
PBQ (evaluation form C)
Instruments (i.e. guitar, piano, ocean disc, etc)
Recording equipment (e.g., laptop with garage band app and CD port, microphone, speakers)
Blank CD and cover
Coloring materials for CD cover art
Procedure
1. Begin the session by reviewing the Take-Home Tips from session 2 and check-in to see how
they went. Review the two techniques from session 2 and have the mother share any new
jingles she created. Encourage mother to try the Multimodal Stimulation technique again and
check-in to see how she is doing.
2. If the bonding song was not completed during session 2, finish the necessary steps to complete
the song. Once completed, encourage the mother to sing the new song to her baby. If she
desires, you may record the song, which she can then play for her baby. Remind the mother
that the optimal experience is for her to sing live to her baby. While the CD is being burned,
have mother create artwork for the CD cover as another expressive outlet.
3. Allow mother to fill out post-questionnaire, MIBS and PBQ and discuss answers to the
questionnaire.
4. Review the four techniques and remind the mother that she has all the tools now to interact and
engage with her child in a positive, creative way. Encourage her to continue to use the jingles
12
Making Music with Mommy and Me
A Perinatal Music Therapy Program
that were created and, of course, sing the bonding song. Ask mother if she feels comfortable
creating and singing new songs and jingles.
13
Making Music with Mommy and Me
A Perinatal Music Therapy Program
BONDING TECHNIQUES
Technique 1: Auditory Stimulation
This technique encourages the mother to speak to her baby, using her voice as a way of telling her
baby she is there and that she loves him/her. The mother may choose to read a book, poem or verse to
her baby and will be encouraged to create a jingle as a positive affirmation for her baby.
Technique 2: Singing mother’s song of kin
For this technique, the therapist encourages the mother to sing her own favorite music to her baby. And
shows her ways to change and alter the song to be more appropriate to sing to an infant. These can
include changing the tempo, time signature, volume and articulation.
Technique 3: Jingles for everyday tasks
This technique encourages mother to create little jingles for everyday tasks such as changing the diaper
and clothing, feeding, washing and playing. The mother will be asked to create her own jingles for
each of these tasks.
Technique 4: Multimodal Stimulation
This last technique encourages the use of singing with massage and rocking. A progression of
massages is listed on the following page with instructions on how to implement this technique.
14
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Technique 4: Multimodal Stimulation Instructions
Sit down in a rocking chair with the baby comfortably in your arms. Sit still, not rocking and begin
when the baby is calm. Do each step for about 30 seconds. If at any time the baby shows signs of
over-stimulation (listed on the following page), stop and wait until the baby is calm again.
1. Sing only
2. Sing and massage
a. head – in a line on the sides and back of head
b. back- in a line from neck to bottom
c. back – in a big circle over the entire back
d. neck – in a line on the sides and throat area
e. arms – in a line or circle
f. chest and belly – in a line from neck to belly button
g. legs – in a line or circle
h. cheeks – in a line from eye to jaw
i. forehead – in a line from left to right or right to left
j. nose to ear – in a line
3. Sing and rock – in slow, steady, rocking motion
4. Sing, rock and massage
a. head – in a line on the sides and back of head
b. back- in a line from neck to bottom
c. back – in a big circle over the entire back
d. neck – in a line on the sides and throat area
e. arms – in a line or circle
f. chest and belly – in a line from neck to belly button
g. legs – in a line or circle
h. cheeks – in a line from eye to jaw
i. forehead – in a line from left to right or right to left
j. nose to ear – in a line
15
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Common signs of overstimulation
•
“Stop” hand - this looks like the baby is saying, “stop” or “wait” with his/her hand. The palm
is facing out toward you
•
Grimace/red face - the baby looks like he/she is about to cry or is uncomfortable, or the baby’s
face suddenly gets red or reddish-purple
•
Crying
•
Startle reflex - the baby’s whole body jerks
•
Tense fingers - the baby spreads his fingers out and the fingers are stiff or tense
•
Arched back - when the baby’s back bends backward and the belly is pushed forward, as if the
baby is trying to get away from what is in front of him/her
•
Hiccups – while they may not be the sign of over-stimulation, it can be stressful and it is best to
wait for them to pass before continuing with any stimulation
Common positive responses
•
Faces you – the baby’s head and face is turned toward you, looks like the baby is looking at
you, even though baby’s eyes may be closed
•
Eye contact – the baby’s eyes look at your eyes
•
Smiling – the baby smiles even if asleep
•
Vocalization – the baby uses his/her voice by cooing, “talking”, sighing, etc.
•
Snuggling – the baby gets closer to you or settles into your arms.
Tips for infant massage
•
Use two or three fingers for massage, and a firm but gentle stroke.
•
The touch should be firm enough so the baby will feel massaged, but not so firm that it would
hurt the baby.
•
Use enough pressure that it doesn’t tickle the baby’s skin, because that may be upsetting.
•
Your stroke/massage should probably move the baby’s skin a little beneath your fingers.
16
Making Music with Mommy and Me
A Perinatal Music Therapy Program
OPTIONS FOR SONGWRITING
When it comes time to begin working on the bonding song, use this page as a guide to decide which
songwriting option the mother will work on. Each option is described and benefits of each are listed.
For songs suggestions please refer to the List of Suggested Songs on page 20.
Option 1: Lyric Substitution
A familiar song is used leaving some words out which the mother then fills in with her own lyrics.
This method provides more structure for the mother and is ideal for those weary of songwriting.
Option 2: Song Recreation
Uses the music of a familiar song, but creates new lyrics or uses lyrics of familiar song and creates
music. Also the mother may bring in a poem, verse, or quote which she then sets to music.
Option 3: Original Song
(by mother and therapist)
The mother creates both the music and the lyrics with the assistance of the music therapist. Music
therapist may provide themes for lyrics and music and guides the mother to make decisions.
Option 4: Original Song
(by the therapist)
The mother may discuss the lyrics with the therapist, but ultimately the therapist is the one to construct
them as a song, also adding the music.
17
Making Music with Mommy and Me
A Perinatal Music Therapy Program
OPTIONS FOR SONGWRITING
Steps
Option 1: Lyric Substitution
STEP1: Select the song to be used. See the List of Suggested Songs for ideas or use a song from the
mother’s interests.
STEP 2: Sing the selected song and then decide which words you will keep/replace.
STEP 3: Fill in the blank spaces to complete the song.
STEP 4: Sing new song and make necessary changes.
STEP 5: Give a title to the new song.
Option 2: Song Recreation
STEP 1: Select the song to be used. See the List of Suggested Songs for ideas or use a song from the
mother’s interests. *If the mother chooses to bring in a poem, verse or quote, begin by reading and
discussing the meaning and impact it has for the mother.
STEP 2: Sing the song and then decide if you are going to keep the words or the melody.
STEP 3: If keeping the lyrics, begin discussing new melodies or motifs to use. If keeping the melody
discus themes to begin creating new lyrics.
STEP 4: Formulate the new melody or new lyrics, add with the old lyrics or old melody, and sing new
song.
STEP 5: Give a title to the new song.
18
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Option 3: Original Song
(by mother and therapist)
STEP 1: Begin by discussing themes for the bonding song and keep notes of the ideas developed.
STEP 2a: Using the theme, develop a chorus or hook for the song.
STEP 2b: Using the other ideas discussed, develop the verses for the song.
STEP 3: Develop the melody for the chorus and verses and decide on accompaniment style and the
instruments to use.
STEP 4: Sing the song and make necessary changes.
STEP 5: Give a title to the new song.
* steps 2a/2b and step 3 may switch if the mother chooses to begin by creating a melody and then
adding lyrics second.
Option 4: Original Song
(by the therapist)
STEP 1: Begin by discussing themes for the bonding song and keep notes of the ideas developed.
STEP 2: Take the ideas and create the verse and chorus of the song as well as the melody,
accompaniment style and instrumentation. Discuss all of these elements, however, the music therapist
is the one creating them.
STEP 3: Bring the created song to the mother and discuss any changes
STEP 4: Sing the song and make necessary changes.
STEP 5: Give a title to the new song.
19
Making Music with Mommy and Me
A Perinatal Music Therapy Program
LIST OF SUGGESTED SONGS
Below is a list of suggested songs in alphabetical order. These songs should be used for option 1 and
option 2 of the Options of Songwriting. For a description of the options, please see page 17.
A Dream is a Wish Your Heart Makes- Cinderella
Kumbaya
All I Have to Do Is Dream- The Everly Brothers
Little Boy Blue
Cradle Song
Little Bo Peep
Amazing Grace
Mary Had A Little Lamb
Angel- Sarah McLachlan
Moon Shadow- Cat Stevens
Baby Mine- Dumbo
My Bonnie Lies Over the Ocean
Blackbird- The Beetles
My Favorite Things- Sound of Music
Danny Boy
Once Upon a Dream
German Cradle Song
Rock a Bye Baby
Goodnight, My Angel- Billy Joel
Somewhere Over the Rainbow- Israel
He’s Got the Whole World
Kamakawiwo’ole
Here Come the Sun- The Beatles
Sounds of Silence- Simon & Garfunkel
Hush Little Baby
Swing Low Sweet Chariot
I Want to Hold Your Hand- The Beatles
Too Ra Loo Ra Loo Ral- Bing Crosby
The Itsy Bitsy Spider
Twinkle, Twinkle Little Star
Jesus Loves Me
You Are My Sunshine
Just the Way You Are- Billy Joel
When You Wish Upon a Star
20
Making Music with Mommy and Me
Pre-Questionnaire
A Perinatal Music Therapy Program
GENERAL INFORMATION
Mother’s Name: ____________________________________________
Phone number: ____________________
DOB: _________________
Email address: __________________________________
Child’s Name: _____________________________________________
DOB: _________________
Siblings: __ yes __ no if yes, how old ___________________________________________________
MUSIC BACKGROUND
What is the typical role of music in your life? (check all that apply)
__ I listen to music in the car or at home
__ I like to sing, but only in the shower
__ I have musical instruments sitting around and dabble with them here and there
__ I play a musical instrument
if yes, what do you play ________________________________________________________
__ I make music with other people sometimes/often (please circle)
__ I turn to music when I am going through a hard time or feeling bad
__ Other __________________________________________________________________________
What genre of music do you enjoy: (check all that apply)
__ Alternative Rock
__ Blues
__ Chant
__ Classical
__ Country
__ Death metal
__ Disco
__ Folk music
__ Funk
__ Heavy metal
__ Hip Hop
__ Indie rock
__ Jazz
__ Musical theatre
__ Opera
__ Pop music
__ Punk rock
__ Rap
__ Reggae
__ Rhythm and blues
__ Rock and Roll
__ Soul/Gospel
__ Spiritual
__ Techno
What radio stations, songs, or artists do you usually listen to?
__________________________________________________________________________________
Songwriting
Have you ever written a song?
Have you ever written a poem?
__ yes __ no
__ yes __ no
Comfort level on song writing
comfortable
(1) very
(2) some what
uncomfortable
(3) neutral
(4) some what
(5) very
21
Making Music with Mommy and Me
Pre-Questionnaire
A Perinatal Music Therapy Program
What are your expectations/wishes for this program?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Any other information the music therapist should know?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________
Mother’s Name: ________________________
Administered by: _______________________
Date: _____________
22
Making Music with Mommy and Me
Perinatal Music Therapy Program
Maternal-Infant
Bonding Scale
MATERNAL-INFANT BONDING SCALE
These questions are about your feelings for your child in the first few weeks. Some adjectives are listed
below which describe some of the feelings mothers have towards their baby in the first weeks after they
were born. Please make a tick against each word in the box, which, best describes how you felt in the first
few weeks.
VERY MUCH
A LOT
A LITTLE
NOT AT ALL
Loving
Resentful
Neutral or felt
nothing
Joyful
Dislike
Protective
Disappointed
Aggressive
Mother’s Name: _____________________________
Score: ____________
Administered by: ____________________________
Date: _____________
23
Making Music with Mommy and Me
Perinatal Music Therapy Program
Maternal-Infant
Bonding Scale
SCORING
VERY MUCH
A LOT
A LITTLE
NOT AT ALL
Loving
0
1
2
3
Resentful
3
2
1
0
Neutral or felt
nothing
3
2
1
0
Joyful
0
1
2
3
Dislike
3
2
1
0
Protective
0
1
2
3
Disappointed
3
2
1
0
Aggressive
3
2
1
0
24
Making Music with Mommy and Me
Postpartum Bonding
Questionnaire
A Perinatal Music Therapy Program
POSTPARTUM BONDING QUESTIONNAIRE
Please indicate how often the following are true for you. There are no “right” or “wrong” answers. Choose
the answer that seems right in your recent experience.
Always
Very
often
Quiet
often
Sometimes
Rarely
Never
I feel close to my baby
I wish the old days when I had no baby would come back
I feel distant from my baby
I love to cuddle my baby
I regret having this baby
The baby does not seem to be mine
My baby winds me up
My baby irritates me
I feel happy when my baby smiles or laughs
I enjoy playing with my baby
My baby cries too much
I feel trapped as a mother
I resent my baby
My baby is the most beautiful baby in the world
I wish my baby would somehow go away
I have done harmful things to my baby
My baby makes me anxious
I am afraid of my baby
My baby annoys me
I feel confident when changing my baby
I feel the only solution is for someone else to look after my baby
I feel like hurting my baby
My baby is easily comforted
Mother’s Name: __________________________
Administered by: __________________________
Date: _____________
25
Making Music with Mommy and Me
Post- Questionnaire
A Perinatal Music Therapy Program
GENERAL INFORMATION
Mother’s Name: ____________________________________________
Phone number: ____________________
DOB: _________________
Email address: __________________________________
QUESTIONNAIRE
Please answer the following questions based on your experience during “Making Music with Mommy
and Me.”
1. Now that you have completed the bonding song, how comfortable do you feel about songwriting?
comfortable
(1) very
uncomfortable
(2) some what
(3) neutral
(4) some what
(5) very
2. Did you enjoy creating the bonding song?
yes
no
Explain: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. Have you implemented any of the four bonding techniques?
yes
no
Which one(s): ______________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4. Do you feel closer to your baby after completing “Making Music with Mommy and Me”?
yes
no
Explain: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
26
Making Music with Mommy and Me
Post-Questionnaire
A Perinatal Music Therapy Program
5. Were your expectations of “Making Music with Mommy and Me” met?
yes
no
Explain: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Mother’s Name: ________________________
Administered by: _______________________
Date: _____________
27
Making Music with Mommy and Me
Perinatal Music Therapy Program
POSTPARTUM DEPRESSION INFORMATION
Postpartum depression affects up to 1 in 7 women, according to the American Psychological
Association (Postpartum Depression, n.d.). The DSM-V recognized that anxiety and depression may
occur both during and after pregnancy and has revised the once called major depressive disorder with
postpartum onset to major depressive disorder with perinatal onset (Wenzel & Kleiman, 2015).
Postpartum anxiety and depression can take on various forms including generalized anxiety, panic
attacks, social anxiety, obsessions and compulsions, and posttraumatic stress. While there are risk
factors any mother may experience these symptoms.
Music therapists who implement this program may come across mothers who are showing
signs and symptoms of postpartum depression. Below is information and resources to provide mothers
with, who may be experiencing post-partum depression. While music therapist are not qualified to
diagnosis postpartum depression they are ethical responsible to provide the necessary resources for the
mother.
The Edinburgh Postnatal Depression Scale (EPDS) can be used as a resource as well (see
page 30).
Symptoms may include:
•
Feelings of anger or irritability
•
Lack of interest in the baby
•
Appetite and sleep disturbance
•
Crying and sadness
•
Feelings of guilt, shame or hopelessness
•
Loss of interest, joy or pleasure in things they used to enjoy
•
Difficulty bonding with her baby
•
Feeling regret for having a baby
•
Possible thoughts of harming the baby or themselves
28
Making Music with Mommy and Me
Perinatal Music Therapy Program
POSTPARTUM DEPRESSION RESOURCES
Postpartum Support International supports all pregnant, postpartum, and post-loss
families through regional, state, and national support coordinators; telephone hotlines;
chats; forums; and groups. http://www.postpartum.net
2020 Mom engages advocates in maternal mental healthcare to drive change in their
communities and states. They’re on a mission to close gaps in care through education,
advocacy, and collaboration. https://www.2020mom.org
Postpartumprogress.com is the world’s most widely read blog dedicated to maternal
mental illness. It offers warm, positive, in-depth information, support and hope for all
pregnant and new moms who experience postpartum depression and all other mental
illnesses related to pregnancy and childbirth, including postpartum anxiety,
postpartum OCD, depression or anxiety during pregnancy, post-adoption depression,
postpartum PTSD, bipolar, peripartum onset/postpartum bipolar, depression after miscarriage or
perinatal loss and postpartum psychosis. A list of support groups in each state can be found on this
page http://www.postpartumprogress.com/postpartum-depression-support-organizations-in-the-uscanada-uk-south-africa-australia-new-zealand
Edinburgh Postnatal Depression Scale (EPDS)
The EPDS is a 10-ietm self-repot scale used to screen for postnatal depression. Each question
is scored; mothers who score higher than 10 are likely to be suffering from depression (Cox, Holden,
Sagvosky, 1987).
29
Making Music with Mommy and Me
Perinatal Music Therapy Program
EDINBURCH POSTNATAL DEPRESSION SCALE (EPDS)
Please check the answer that comes closest to how you have felt in the past 7 days, not just how you
feel today.
Here is an example, already completed.
I have felt happy:
Yes, all the time
Yes, most of the time
No, not very often
No, not at all
In the past 7 days:
1.
I have been able to laugh and see the funny side of things
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
2.
I have looked forward with enjoyment to things
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
3.
4.
5.
I have blamed myself unnecessarily when things went wrong
Yes, most of the time
Yes, some of the time
Not very often
No never
I have been anxious or worried for no good reason
No, not at all
Hardly ever
Yes, sometimes
Yes, very often
I have felt scared or panicky for no very good reason
Yes, quite a lot
Yes, sometimes
No, not much
No, not at all
6.
Things have been getting on top of me
Yes, most of the time I haven’t been able to cope
at all
Yes, sometimes I haven’t been coping as well as
usual
No, most of the time I have coped quite well
No, I have been coping as well as ever
7.
I have been so unhappy that I have had difficulty
sleeping
Yes, most of the time
Yes, sometimes
Not very often
No, not at all
8.
I have felt sad or miserable
Yes, most of the time
Yes, quite often
Not very often
No, not at all
9.
I have been so unhappy that I have been crying
Yes, most of the time
Yes, quite often
Only occasionally
No, never
10. The thought of harming myself has occurred to me
Yes, quite often
Sometimes
Hardly ever
Never
Mother’s Name: _____________________________
Score: _____________
Administered by: ____________________________
Date: ___________
30
Making Music with Mommy and Me
Perinatal Music Therapy Program
INSTRUCTIONS AND SCORING
Instructions
1. The mother is asked to check the response that comes closet to how she has been feeling in the
previous 7 days
2. All the items must be completed
3. Care should be taken to avoid the possibility of the mother discussing her answers with others
(answers come from the mother or pregnant woman)
4. The mother should complete the scale herself, unless she has limited English or has difficulty
with reading
Scoring
Questions 1, 2 & 4
Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3
Questions 3, 5-10
Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0
Maximum score:
30
Possible Depression:
10 or greater
*Always look at item 10 (suicidal thoughts)
31
Making Music with Mommy and Me
Perinatal Music Therapy Program
MUSIC THERAPY RESOURCES
Books
1. Music Therapy and Parent Infant Bonding edited by Jane Edwards
2. Music Therapy in Neonatal Intensive Care Unit by Joanne Loewy
3. Music Therapy with Premature Infancts by Jayne Standley and Darcy Walworth
4. Songwriting: Methods, Techniques and Clinical Application for Music Therapy Clinicians,
Educators and Students by Felicity Baker and Tony Wigram
5. Integrative Health Through Music Therapy Accampanying the Journey from Illness to
Wellness by Suzanne Hanser
6. Cognitive Behavior Therapy for Perinatal Distress by Amy Wenzel and Karen Kleiman
32
Making Music with Mommy and Me
Perinatal Music Therapy Program
GUIDEBOOK REFERENCES
Brockington, I. F., Oates, J., George, S., Turner, D., Vostanis, P., Sullivan, M., & ...
Murdoch, C. (2001). A Screening Questionnaire for mother-infant bonding disorders. Archives
Of Women's Mental Health, 3(4), 133-140.
Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh
Postnatal Depression Scale (EPDS). London, England: Royal College of Psychiatrists
Hanser, S. B. (2016). Integrative health through music therapy accompanying the
journey from illness to wellness. United Kingdom: Palgrave Macmillan.
Loewy, J. (2000) Music therapy in neonatal care unit. New York: Satchnote Press
Nocker-Ribaupierre, M.(2013). Premature infants. In Bradt, J. (Ed.), Guidelines for music therapy
practice in pediatric care (66-115). Gilsum, NH: Barcelona Publishers
Perrelli, J. A., Zambaldi, C.F., Cantilino, A., & Sougey, E. B. (2014). Mother-child bonding
assessment tools. Revista Paulista De Pediatria: Orgao Oficial Da Sociedade De Pediatria De
Sao Paulo, 32(3), 257-265.
Postpartum Depression. (n.d.) In American Psychological Association online. Retrieved
from
http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx
Santrock, J., W. (2008). A topical approach to life-span development. New York, New
York: MGraw-Hill.
Standley, J. M., Walworth, D. (2010). Music therapy with premature infants. Silver
Spring, Maryland: American Music Therapy Association, Inc.
Wenzel, A., Kleiman, K., (2015). Cognitive behavioral therapy for perinatal distress.
New York, New York: Routledge Taylor and Francis Group.
33
Making Music with Mommy and Me
Perinatal Music Therapy Program
34
“Making Music with Mommy and Me”: A Perinatal Music Therapy Program
Alicia Drexel
Berklee College of Music
MAKING MUSIC WITH MOMMY AND ME
Abstract
Making Music with Mommy and Me is a perinatal music therapy program
designed for mothers who want to connect more with their infants. This program aims to
use the technique of songwriting and other music based bonding techniques to tap into
the creativity of the mother as a way for her to bond with her baby and form healthy
maternal-infant attachments. An accompanying guidebook provides music therapists
with a pre-questionnaire, assessment forms, a post-questionnaire, as well as session
outlines, a list of suggested songs, and options for songwriting. By the end of this threesession program, the mother will have learned techniques to bond with her baby, and
created a bonding song, which she can sing to her newborn baby.
Keywords: music therapy, postpartum depression, attachment, bonding, perinatal
2
MAKING MUSIC WITH MOMMY AND ME
3
Acknowledgments
I would like to thank everyone who helped shape this project. First to my amazing
chairperson, Dr. Suzanne Hanser, thank you for your unending support in first helping me
form my original ideas into this project and then for your guidance in developing the
guidebook and pushing me to articulate everything clearly. Thank you to Dr. Joy Allen,
and Heidi Lengel for coming aboard my committee and providing insight and knowledge
regarding this area of music therapy. To my family, thank you for all your love and
support as I went through this journey and for always believing in me.
I am grateful to have been a part of the second graduating class of the graduate
music therapy program at Berklee College of Music and to have been among many
inspiring music therapists. My experience has changed me as a music therapist, and I
will always be thankful for the connections I made.
Lastly, I acknowledge that I would not have been able to complete this without
the help from above. “I can do all things through Christ who strengthens me”
~Philippians 4:13. And that this was all part of His plan for me. “For I know the plans I
have for you, declares the Lord, plans to prosper you and not to harm you, plans to give
you a hope and a future” ~Jeremiah 29:11
MAKING MUSIC WITH MOMMY AND ME
4
Table of Contents
Abstract……………………………………………………………………………………2
Acknowledgments…………………………………………………………………………3
PART A: Background and Development of the Guidebook- Making Music with Mommy
and Me: A Perinatal Music Therapy Program ……………………………………………5
1. INTRODUCTION……………………………………………………………………...7
2. LITERATURE REVIEW………………………………………………………………8
2.1 Pregnancy Stressor and Postpartum Depression.……………………………...8
2.2 Attachment. …………………………………………………………………...9
2.3 Music and Pregnancy………………………………………………………...11
2.4 Music Therapy and Pregnancy……………………………………………….12
2.5 Music and Early Infant- Mommy and Me Programs ………………………..14
2.6 Rationale and Purpose………………………………………………………..15
3. METHODS……………………………………………………………………………15
3.1 Qualifications and Training.………………………………………………....16
3.2 Settings and Materials……………………………………………..................17
3.3 Session-by-session……………………………………………………...……17
3.4 Evaluation Tools……………………………………………………………..19
4. CONCLUSIONS AND RECOMMENDATIONS.…………………………………...21
5. REFERENCES………………………………………………………………………..23
PART B: Guidebook- Making Music with Mommy and Me: A Perinatal Music Therapy
Program…………………………………………………………………..……………... 28
MAKING MUSIC WITH MOMMY AND ME
PART A
Background and Development of The Guidebook- Making Music with
Mommy and Me: A Perinatal Music Therapy Program
5
MAKING MUSIC WITH MOMMY AND ME
6
Part A contains background information and details of the development of the
guidebook- Making Music with Mommy and Me: A Perinatal Music Therapy Program.
This program was developed to address a key area of development in neonate: attachment
and bonding. The introduction and literature review explain the need and importance of
the bond between a mother and infant, as well as the challenges that may arise during
pregnancy and postpartum that can hinder this process. A brief look at the current
research in music therapy, as well as current programs available for this population is
also discussed. An explanation of each part of the guidebook is described as well as the
selection of the bonding techniques.
The guidebook can be found in Part B - Making Music with Mommy and Me: A
Perinatal Music Therapy Program. The guidebook provides music therapists with a prequestionnaire, assessment forms, a post-questionnaire, as well as session outlines, list of
suggested songs, and options for songwriting. The guidebook also contains resources for
postpartum depression and details of the four bonding techniques that are implemented in
the three sessions.
MAKING MUSIC WITH MOMMY AND ME
7
Introduction
Music is universal! People of all ages and cultures can listen, perform, create and
enjoy music (Davis, Gfeller & Thaut, 2008). Music is multisensory: auditory, visual,
tactile and kinesthetic (Bruscia, 1998). Music is unique to humans and is part of the
culture and history. Music is both active and receptive in nature; composition,
improvisation, performance and listening each have significant roles (Bruscia, 1998).
Music is fundamental in bringing people together. Whether in a communal fashion with
many or in more intimate family gathering, music has had a role and impactful power to
bring people to bring people together for centuries (Davis, Gfeller & Thaut, 2008). It not
only brings people together but can also create relationships and bonds between people.
Forming these attachments is crucial for our survival as humans; we need to feel
connected and a part of something. It is a human need to develop close emotional bonds
as a biological function of survival (Bowlby, 2008). These relationships and attachments
begin early in our lives. It is therefore important for mother and baby to form healthy
attachments in order to promote growth and health in both baby and mother postpartum
or after birth. These healthy attachments are not only crucial during the perinatal stage of
pregnancy, but will impact the future relationship between baby and mother (Maddahi,
Dolatian, Khoramabadi & Talebi, 2016). Research supporting the challenges inherent
during pregnancy and during postpartum are presented here, along with findings
regarding the role of music in pregnancy and after the birth. As can be seen in the
literature, the universal, multisensory, unique phenomenon that is fundamental in
bringing people together may also aid and support this process of maternal-infant
attachments.
MAKING MUSIC WITH MOMMY AND ME
8
Literature Review
Pregnancy Stressors and Postpartum Depression
Both pregnancy and postpartum period can bring many challenges for baby and
mother. Pregnancy can be a stressful time in a woman’s life. Mothers may be
experiencing changes in emotional, physical and social aspects of life (Shin & Kim,
2011). These stressors can increase when the pregnancy becomes a high-risk pregnancy
or the mother experiences any form of trauma during pregnancy. In addition to “normal”
stressors, mothers may experience stress related to hospitalization, their risk status, and
concerns over the health of the baby (White et al., 2008; Shin & Kim, 2011).
The transition into parenthood can also be stressful and mothers and/or caregivers
may experience other challenges during this time. Mothers may experience anxiety and
depression during their pregnancy and this can continue postpartum as well. Postpartum
depression affects up to 1 in 7 women, according to the American Psychological
Association (Postpartum Depression, n.d.). The DSM-V recognized that anxiety and
depression may occur both during and after pregnancy and has revised the once called
major depressive disorder with postpartum onset to major depressive disorder with
perinatal onset (Wenzel & Kleiman, 2015). Postpartum anxiety and depression can take
on various forms including generalized anxiety, panic attacks, social anxiety, obsessions
and compulsions, and posttraumatic stress. While there are risk factors any mother may
experience these symptoms.
Other stressful life events can also cause postpartum depression. A study done by
Salm, Kanu, & Robb (2017) examined how SLE’s were related to postpartum depression.
They looked at three SLE’s: arguments with partner, trouble paying bills, and
MAKING MUSIC WITH MOMMY AND ME
9
separation/divorce. It was concluded that experience high stress significantly predicted
postpartum depression.
Postpartum depression not only affects the mother, but can have a lasting effect
on the child as well. Closa-Monasterolo et al. (2017) looked at the effect of postpartum
depression and current mental health problems of the mother on child behavior at eight
years. They concluded that maternal postpartum depression and current mental health
problems, separately and synergistically, increase children's psychological problems at
8 years. Postpartum depression is also associated with decreased infant bonding,
impaired child development, marital discord, suicide, and infanticide (Wilkinson,
Anderson, & Wheeler, 2016).
There are various pharmacologic and non-pharmacologic treatment methods for
postpartum depression. In 2007, Msri & Kendrick (2007) conducted a literature search
on the treatment modalities used in the treatment in postpartum depressions. They found
that women with perinatal depression and anxiety disorders require timely and efficient
management with a goal of providing symptom relief for the suffering mother while
simultaneously ensuring the baby's safety. They also stated that although knowledge in
the area of appropriate intervention is constantly evolving, rigorous and scientifically
sound research in the future is critical. The purpose of the guidebook in this document is
to provide mothers with a resource to work on improving their bonds with their babies,
addressing one of the issues common in postpartum depression.
Attachment
Attachment is defined as “a close emotional bond between two people” (Santrock,
2008, p.360). Many theorists have views on why infants become attached to their mother
MAKING MUSIC WITH MOMMY AND ME
10
or caregiver. For example, Freud notes that infant become attached to the person or
object that provides oral satisfaction, whereas Erikson believed physical comfort and
contact play a role in developing those attachments. Bowlby (2008), however, believed
that infants and their caregivers are predisposed to form attachments and that there are
four phases in developing the attachments. He believed that infants develop an internal
working model of attachment, a simple mental model of the caregiver, their relationship,
and the self as deserving of nurturing care (Bowlby, 2008).
Another set of theorists (Fonagy et al., 1995) believed in the theory of reflective
functioning (RF). Reflective functioning is the capacity to understand that one’s own or
another’s behaviors are linked in meaningful ways to underlying mental states such as
feelings, wishes, thoughts, and desires. Fonagy and colleagues suggested that secure
attachment is the direct outcome of successful containment, which is the parent’s ability
to reflect the infant’s internal state and represent that state for the infant as a manageable
experience. So not only does the mother have to understand the behavior demonstrated
by the infant, but she also must communicate that in a way that is a model for the infant.
Grienenberger, Kelly and Slade (2005) studied the correlation between mental states and
observed caregiver behavior in the intergenerational transmission of attachment. The
results of their study supported this theory of attachment, and further explained that
infants rely on their mothers to respond at the behavioral level relative to the mother’s
affective state.
Forming healthy attachments is crucial for infants and a necessary part of their
growth and development. It is both a physical and psychological need of babies that
provides comfort and protection. The mother is typically the first emotional attachment
MAKING MUSIC WITH MOMMY AND ME
11
of the child and therefore will have an impact on all future attachments the infant
develops (Perrelli, 2014). This bond, however, may not come naturally for the mothers,
but is an ongoing process starting during pregnancy and continuing once the infant is
born.
How can parents support this process? What can they do to promote healthy
attachments? Some studies have shown that singing lullabies to the infant promotes
maternal-infant bonding (Persico et al., 2017), while others focus on eye-to-eye contact
(Robson, 1975). The benefit of singing is that is can be done during pregnancy. Mothers
can sing to their babies and babies can begin to recognize their mother’s voice. A study
by Damastra-Wijmenga (1991) concluded that babies pay special attention to their
mother’s voices over other women’s voices and even to a lullaby, which the mother had
played for them. Babies begin to respond to sounds during the third trimmest of
development at about 32 weeks (Santrock, 2008). Therefore, these attachments can begin
during the beginning of the perinatal phase of pregnancy. While there are various
opinions on what the perinatal phase consists of, this protocol will be focusing on the
postpartum end of the spectrum and will include birth to one-year.
Music and Pregnancy
Music can have a role in reducing stressors associated with typical and high-risk
pregnancies. Active music making, listening to music and singing can reduce the stress
of the mother and therefore promote healthy development of the neonate (Arabin & Jahn,
2013). In addition to reducing the stressors, mothers are able to “interchange emotions
with their infants” (p 357), and increase the bond between them. While neonates will not
understand the meaning of words, they are able to comprehend elements of the music,
MAKING MUSIC WITH MOMMY AND ME
12
such as the musicality and rhythm of language, and begin to from a bond with the mother
and her voice.
Music Therapy and Pregnancy
Music therapy has also played a role in perinatal phases. It has been used to
promote relaxation during labor and delivery (Hanser, Larson & O’Connell, 1983; Clark,
McCorkle & Williams, 1981) and during transvaginal ultrasounds (Shin & Kim, 2011)
and has addressed areas, such as alleviating stress during antepartum hospitalization
(Bauer et al., 2010) and the psychological health of women during pregnancy (Mei-Yuah,
Chung-Hey & Kuo-Feng, 2008). However, there is little research on the effects of music
therapy in regard to maternal-fetal attachment. Chang, Chen & Chen (2015), recommend
further study investigating the long-term effect of listening to music on childbirth
outcomes and postnatal psychology of women.
Music therapy has also played a role during the postpartum phase. Researchers
such as Jayne Standley and Joanne Loewy have both pioneered various techniques and
interventions for use of music therapy with premature infants. In her book, “Music
Therapy with Premature Infants” (2010), Standley describes three techniques to be used
in the NICU. They include sustained live music, music and non-nutritive sucking (NNS)
and music and multimodal stimulation. While all of these techniques require the
implementation by a NICU trained music therapist, the multimodal stimulation can be
done with the parent facilitated by the music therapist. Joanne Loewy pioneered another
music therapy training called First Sounds RBL (rhythm, breath, lullaby). Through this
intensive training music therapist learn various techniques to be implemented in the
NICU, which emphasizes on healthy dyadic or triadic relationships, trauma amelioration,
MAKING MUSIC WITH MOMMY AND ME
13
and neuropsychological development (“The development of,” n.d.). The focus in both of
these NICU training is primarily on the hospitalized infant, while both do include the
mother or caregivers, the emphasis is on infant outcomes and typically takes place in the
hospital.
Joanne Loewy also edited a book titled “Music Therapy in the Neonatal Intensive
Care Unit” (2000) in which chapters inform readers of the current research and clinical
practice of music therapy in the NICU. Areas of content include how to institute a NICU
Music therapy program, the effects on feeding, research on infant-directed singing and
clinical techniques using both live and taped music in the treatment of neonates and their
families. Another resource edited by Jane Edwards is, “Music therapy and parent infant
bonding” (2011). This book includes three sections: (i) music therapy research and
practice to ameliorate vulnerability in infancy; (ii) descriptions of successful group music
therapy programs; and (iii) music therapy work with parents and infants in medical
settings (Edwards, 2011). As stated in the introduction, “this text aims to fill a much
needed gap to provide further support for teaching, practice and ongoing evaluation of
parent-infant bonding in music therapy; ultimately presenting a greater awareness of the
need for funded research that can inform policy and practice” (Edwards, 2011).
There is little music therapy literature focusing on the mothers during postpartum
period. One study done by Keith, Weaver, Vogel (2012) focused on the effect of musicbased listening interventions on the volume, fat content and caloric content of breast
milk. The results of this study showed that mothers in the experimental group produced
significantly more milk with significantly more fat content. Another study, non-music
therapy related, done by Norouzi, SeyedFatemi, and Montazeri (2013) focused on the
MAKING MUSIC WITH MOMMY AND ME
14
implementation of music during kangaroo care. The results of this study showed there
was evidence that kangaroo care had an effect on the severity of maternal anxiety state
but there was no significant difference when music was implemented. This investigation
suggested a need for more research to document the effectiveness of selected or familiar
music during kangaroo care on state anxiety in early postpartum.
The current project focuses on the development of a music therapy program
aimed to promote maternal-infant attachments. The primary music therapy intervention
is songwriting. This is a technique used in music therapy for many purposes. In some
cases, the therapist is writing an original composition to use in therapy; in others, the
patient/client is involved in the songwriting experience as therapy (Baker & Wigram,
2005). The Mommy and Me program presented here aims to use techniques, including
songwriting, and tap into the creativity of mothers as a way for them to bond with their
babies and form healthy maternal-infant attachments. Other bonding techniques, such as
auditory stimulation, jingles for everyday task, singing songs of kin and multimodal
stimulation, will also be introduced, and are explain further in the session-by-session plan
section found in Part B.
Music and Early Infant- Mommy and Me Programs
There are various Mommy and Me music programs that exist. Some include:
Music Together (Music Together, 2018), Sprouting Melodies (Sprouting Melodies,
2018), and Programs at Carnegie Hall such as The Lullaby Program (Carnegie Hall
Education, 2018). Music Together is an early childhood music and movement program
for children from birth through age eight and mothers, father, grandparents, nannies, etc.
They value the concept that children learn best from the role models in their lives, which
MAKING MUSIC WITH MOMMY AND ME
15
is why those individuals are a part of the groups. Classes are offered all over the country
at various locations through trained Music Together teachers. The program contains nine
different collections that contain a mix of original and traditional tunes (Music Together,
2018).
Sprouting Melodies is another early childhood music program developed by
music therapist and offers a development-based approach to infant and toddler music
classes. These groups are offered through music therapists who have completed the
Raising Harmony Early Childhood Training Program. Age-specific classes for infants,
toddlers, siblings and preschoolers include experiences that encourage musical, social,
physical, and emotional growth (Sprouting Melodies, 2018).
The Lullaby Project at Carnegie Hall pairs pregnant women and new mothers
with professional artists to write and sing personal lullabies for their babies. This
program recently released a CD with some of the original lullabies titled Hopes &
Dreams (Carnegie Hall Education, 2018).
Making Music with Mommy and Me: A Perinatal Music Therapy Program
incorporates ideas and principles from each of these programs. It is designed and should
be implemented by a music therapist; it is aimed to work with mothers and their infants;
and it includes the songwriting as the primary medium to promote bonding between the
mother and infant.
Rationale and Purpose
There is little music therapy literature on the use of songwriting within perinatal
populations. So it appears that a protocol needs to be created and tested in order to serve
this sensitive population. The aim of the suggested music therapy protocol in this project
MAKING MUSIC WITH MOMMY AND ME
16
is to provide new mothers the opportunity to use therapeutic songwriting as a way to
form healthy attachments with their neonate. Outcomes may include: positive effects on
neonate and maternal stress, lowered maternal anxiety, and promotion of social
development in the neonate. In a second phase beyond the scope of the author’s
culminating project, this perinatal music therapy protocol would be implemented and
evaluated. This would contribute to evidence on the impact of music therapy after the
birth of the baby, specifically in building maternal-infant attachments to promote health
and growth in the neonates and mothers post-pregnancy.
The protocol appears as a guidebook in Part B of this document. It describes
objectives and session plans for a perinatal music therapy program to build maternalinfant attachment in new mothers.
Methods
The guidebook was designed for individual music therapy sessions, as this
process is an intimate experience shared between the mother and baby, facilitated by the
music therapist. This guidebook focuses on the creation of a bonding song, which aims
to increase maternal-infant attachment, and promote bonding between the mother and
neonate. Target recipients include: (1) mothers over 18 years of age; (2) mothers in the
postpartum period of pregnancy, post birth to one year; and (3) mothers without hearing
impairment (based on self-report).
Qualifications and Training
Music therapists who have completed a degree program in music therapy and
passed the music therapy board exam administered by the Certification Board for Music
Therapist are qualified to implement this guidebook. Specialized training in NICU music
MAKING MUSIC WITH MOMMY AND ME
17
therapy is recommended, but not required. It is also recommended that the therapist have
additional training in the area of perinatal music therapy. The author may consider
developing a training program for music therapists to implement this guidebook in the
future.
Setting and materials
This program would be implemented in a quiet space where the music therapist
can meet with the mother, if feasible in the mother’s home. Mothers would be invited to
bring their babies along to the sessions. Required materials include: instruments of the
mother’s choice e.g., guitar, piano/keyboard, ocean drum, etc., which will be provided by
the music therapist; and recording device provided by therapist. Each session description
page contains a list of equipment/materials needed for that session (see Part B).
Session-by-session plan
A detailed set of session plans is articulated in the guidebook. These include
specific instructions for the music therapist to conduct a preliminary meeting, musicmaking and songwriting guidelines, and the recording of a bonding song. The protocol is
for three sessions that last approximately 60 minutes each. For each session, there is a
description page, including goals/objectives, equipment/materials required, procedure and
take-home tips.
During the preliminary meeting, the therapist explains the songwriting process
and the purpose of the intervention. The therapist explains that this is a three-session
program. During each session, the mother is given various bonding techniques to use
with her baby. She also creates her own bonding song with the music therapist. At the
end of each session, there will be take-home tips that are mini tasks for the mother to try
MAKING MUSIC WITH MOMMY AND ME
18
during the week before the next session. These techniques and the bonding song are
ways to promote healthy attachments and improve bonding with her baby. The therapist
also explains that it is necessary for the baby to be present so the music therapist can
demonstrate the various techniques during each session. The therapist also administers
the pre-questionnaire, Maternal Infant Bonding Scale and Postnatal Bonding
Questionnaire (see Evaluation Tools below).
Sessions thereafter include music making, such as singing of familiar songs and
songs of kin, and eventually, the creation of a bonding song. The therapist supports the
mother as much as needed in this process. The music therapist provides templates,
formats and options for creating a bonding song. Those include: lyric substitution, song
recreation, original songwriting done by mother and therapist, or original songwriting
done by the therapist. A recording of their special bonding song is provided for the
mother to use. She will be encouraged to sing this song to the baby when she wishes to
soothe the baby or herself.
Other bonding techniques will also be introduced throughout the three sessions.
These include auditory stimulation (Nocker-Ribaupierre, 2013), singing mother’s song of
kin (Loewy, 2000), jingles for everyday tasks (Hanser, 2016), and multimodal
stimulation (Standley, 2010). Auditory stimulation encourages the mother to speak to her
baby, using her voice as a way of telling her baby she is there and that she loves him/her.
The mother may choose to read a book, poem or verse to her baby, and will be
encouraged to create a jingle that includes an intention for her baby. Singing mother’s
songs of kin encourages the mother to sing her own favorite music to her baby, and the
therapist shows her ways to change and alter the song to be more appropriate to sing to an
MAKING MUSIC WITH MOMMY AND ME
19
infant. These can include changing the tempo, time signature, volume and articulation.
Jingles for everyday tasks encourages mother to create little jingles for everyday tasks,
such as changing the diaper and clothing, feeding, washing and playing. The mother is
asked to create her own jingles for each of these tasks. The multimodal stimulation
encourages the use of singing with massage and rocking. There is a progression for the
massage that is listed in the guidebook. These techniques developed by Standley and
Lowey for use in the NICU have been adapted to use in this guidebook. The focus of the
techniques in the guidebook is teaching the mother how to implement these techniques
normally done by a music therapist.
Evaluation tools
The following evaluation tools are administered to inform the music therapist, and
to determine whether any changes have occurred over the course of the program.
Pre-Questionnaire
This form gathers basic information from the mother and including background
information on the mother, the mother’s music background and expectations from this
program. It is to be filled out during the preliminary session and used during the
remaining sessions as a reference.
Mother-Infant Bonding Scale
The MIBS consists of eight adjectives divided into three aspects: positive,
negative and confused attachment. High scores indicate problems in the mother-infant
bonding (Perrelli, 2014). This scale is used as a pretest and posttest to evaluate changes
in mother-infant bonding.
Postpartum Bonding Questionnaire (PBQ)
MAKING MUSIC WITH MOMMY AND ME
20
The PBQ, a 25-ietm self-report questionnaire, aims to identify problems in the
mother-baby relationship based on four components: 1) weakened bonding; 2) rejection
and pathological rage; 3) anxiety about the baby/anxiety about caring for the baby; and 4)
imminent abuse/risk of abuse (Brokington et al., 2001). This scale is also be used as a
pretest and posttest to assess changes in mother-infant bonding.
Post-Questionnaire
This form is filled out after completion of the program and the recording of the
bonding song. It contains five wrap-up questions evaluating the mother’s experience
with the program. It is completed at the end of the third session.
MAKING MUSIC WITH MOMMY AND ME
21
Conclusions and Recommendations
After fully understanding postpartum depression and all the effects it can have on
not only the mother, but baby and family, it is clear that music therapy may have a role in
addressing those need areas. This protocol and resulting guidebook in Part B of this
document focuses on infant bonding and aims to not only promote maternal-infant
bonding, but also provide the mother with concrete tools that she can implement in her
everyday life to enhance those bonds. The techniques that are used in the guidebook
come from a variety of sources. These techniques are typically used in the medical
setting focusing on the baby; however, this protocol’s main focus is on the mother. How
can we empower the mother to have these tools to bond with her baby?
Making Music with Mommy and Me addresses this important aspect of maternalinfant bonding. This program is aimed to provide mothers with a tool to increase
bonding with their baby. These techniques are meant to be tangible tips on various ways
to implement music into the mother’s and baby’s life to promote bonding.
While the guidebook provides the music therapist with a resource to implement
this program with mothers, this protocol can be adapted to use with fathers, grandparents,
aunts, uncles, older siblings, or anyone who is looking to build a bond and relationship
with this new life that has entered the world. The layout and session outlines are very
structured; however, these techniques and tools may be implemented differently,
depending on the therapist’s intention. If it is not feasible to do the complete program,
the therapist can use and teach the mother one or a few techniques for the purpose of
promoting bonding.
MAKING MUSIC WITH MOMMY AND ME
Other considerations for the future would be the creation of a parent handbook
including these techniques to be given to mothers as a resource, after completing the
program. The next phase would be to pilot this program to study its effectiveness and
validate its outcomes.
22
MAKING MUSIC WITH MOMMY AND ME
23
References
Arabin, B., & Jahn, M. (2013). Need for interventional studies on the impact of music in
the perinatal period: results of a pilot study on women's preferences and review of
the literature. The Journal of Maternal-Fetal & Neonatal Medicine, 26(4), 357362.
Baker, F., & Wigram, T. (2005). Songwriting: methods, techniques and clinical
applications for music therapy clinicians, educators and students. Philadelphia,
PA: Jessica Kingsley Publishers.
Bauer, C. L., Victorson, D., Rosenbloom, S., Barocas, J., & Silver, R. K. (2010).
Alleviating distress during antepartum hospitalization: A randomized controlled
trial of music and recreation therapy. Journal of Women's Health 19(3), 523-531.
Bowlby, J. (2008). Attachment. New York, NY: Basic books.
Brockington, I. F., Oates, J., George, S., Turner, D., Vostanis, P., Sullivan, M., & ...
Murdoch, C. (2001). A screening questionnaire for mother-infant bonding
disorders. Archives Of Women's Mental Health, 3(4), 133-140.
Bruscia, K. E. (1998). Defining music therapy. Gilsum, NH: Barcelona Publishers
Carnegie Hall Education. (2018). Lullaby project. Retrieved 2018, May 23 from
https://www.carnegiehall.org/Education/Social-Impact/Lullaby-Project
Chang, H., Yu, C., Chen, S., & Chen, C. (2015). The effects of music listening on
psychosocial stress and maternal-fetal attachment during
pregnancy. Complementary Therapies in Medicine, 23(4), 509-515.
Clark, M. E., McCorkle, R. R., & Williams, S. B. (1981). Music therapy-assisted labor
and delivery. Journal of Music Therapy, 18(2), 88-100.
MAKING MUSIC WITH MOMMY AND ME
24
Closa-Monasterolo, R., Gispert-Llaurado, M., Canals, J., Luque, V., Zaragoza-Jordana,
M., Koletzko, B., & … Escribano Subias, J. (2017). The effect of postpartum
depression and current mental health problems of the mother on child behavior of
eight years. Maternal And Child Health Journal, 21(7), 1563-1572.
Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh
Postnatal Depression Scale (EPDS). London, England: Royal College of
Psychiatrists
Damstra-Wijmenga, S. M. (1991). The memory of the new-born baby. Midwives
Chronicle, 104(1238), 66-69
Davis, W. B., Gfeller, K. E., & Thaut, M. H. (2008). An introduction to music therapy
theory and practice. Silver Spring, Maryland: American Music Therapy
Association, Inc.
Edwards, J. (2011). Music therapy and parent infant bonding. New York, NY: Oxford
University Press.
Fonagy, P., Steele, M., Steele, H., Leigh, T., Kennedy, R., Mattoon, G., et al. (1995).
Attachment, the reflective self, and borderline states: The predictive specificity of
the Adult Attachment Interview and pathological emotional development. In S.
Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental
and clinical perspectives (pp. 233 – 278). Hillsdale, NJ: The Analytic Press.
Grienenberger, J. F., Kelly, K., & Slade, A. (2005). Maternal reflective functioning,
mother-infant affective communication, and infant attachment: exploring the link
between mental states and observed caregiving behavior in the intergenerational
transmission of attachment. Attachment & Human Development, 7(3), 299-311.
MAKING MUSIC WITH MOMMY AND ME
25
Hanser, S. B., Larson, S. C., & O'Connell, A. S. (1983). The effect of music on
relaxation of expectant mothers during labor. Journal of Music Therapy, 20(2),
50-58.
Hanser, S. B. (2016). Integrative health through music therapy accompanying the
journey from illness to wellness. United Kingdom: Palgrave Macmillan.
Keith, D. R., Weaver, B. S., Vogel, R. L. (2012). The effect of music-based listening
interventions on the volume, fat content, and caloric content of breast milk–
produced by mothers of premature and critically ill infants. Advances in Neonatal
Care, 12(2) 112-119.
Loewy, J. (2000) Music therapy in neonatal care unit. New York, NY: Satchnote Press
Maddahi, M. S., Dolatian, M., Khoramabadi, M., & Talebi, A. (2016). Correlation of
maternal-fetal attachment and health practices during pregnancy with neonatal
outcomes. Electronic Physician, 8(7), 2639-2644.
Mei-Yueh, C., Chung-Hey, C., & Kuo-Feng, H. (2008). Effects of music therapy on
psychological health of women during pregnancy. Journal of Clinical
Nursing, 17(19), 2580-2587.
Misri, S & Kendrick, K. (2007). Treatment of perinatal moddo and anxiety diorders: a
review. Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie,
52(8), 489-498.
Music Together. (2018). What is music together? Retrieved 2018, May 24 from
https://www.musictogether.com/about
NICU music therapy. The development of rhythm, breathe, & lullaby in clinical practice.
MAKING MUSIC WITH MOMMY AND ME
26
(n.d). Retrieved from
http://nicumusictherapy.com/Nicumusictherapy/Training.html
Nocker-Ribaupierre, M.(2013). Premature infants. In Bradt, J. (Ed.), Guidelines for
music therapy practice in pediatric care (66-115). Gilsum, NH: Barcelona
Publishers
Norouzi, F., Keshavarz, M., SeyedFatemi, N., & Montazeri, A. (2013). The impact of
kangaroo care and music on maternal state anxiety. Complementary Therapies In
Medicine, 21(5), 468-472.
Perrelli, J. A., Zambaldi, C.F., Cantilino, A., & Sougey, E. B. (2014). Mother-child
bonding assessment tools. Revista Paulista De Pediatria: Orgao Oficial Da
Sociedade De Pediatria De Sao Paulo, 32(3), 257-265.
Persico, G., Antolini, L., Vergani, P., Costantini, W., Nardi, M. T., & Bellotti, L. (2017).
Maternal singing of lullabies during pregnancy and after birth: Effects on
mother-infant bonding and on newborns’ behavior. Concurrent Cohort Study.
Women and Birth: Journal of The Australian College of Midwives, 30(4).
Postpartum Depression. (n.d.) In American Psychological Association online. Retrieved
from
http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx
Robson, K.S. (1975). The role of eye-to-eye contact in maternal-infant attachment.
Journal of Child Psychology, Psychiatry and Allied Disciplines, 8(1), 13-25
Salm, Ward, T., Kanu, F. A., & Robb, S. W. (2017). Prevalence of stressful life events
during pregnancy and its association with postpartum depressive symptoms.
Archives Of Women’s Mental Health, 20(1), 161-171
MAKING MUSIC WITH MOMMY AND ME
27
Santrock, J., W. (2008). A topical approach to life-span development. New York, New
York: MGraw-Hill.
Shin, H. S., & Kim, J. H. (2011). Music therapy on anxiety, stress and maternal-fetal
attachment in pregnant women during transvaginal ultrasound. Asian Nursing
Research, 5(1), 19-27.
Sprouting Melodies. (2018). Programs and Classes. Retrieved 2018, May 23 from
http://sproutingmelodies.com/programs-classes/
Standley, J. M., Walworth, D. (2010). Music therapy with premature infants. Silver
Spring, Maryland: American Music Therapy Association, Inc.
Wenzel, A., Kleiman, K., (2015). Cognitive behavioral therapy for perinatal distress.
New York, New York: Routledge Taylor and Francis Group.
White, O., McCorry, N. K., Scott-Heyes, G., Dempster, M., & Manderson, J. (2008).
Maternal appraisals of risk, coping and prenatal attachment among women
hospitalised with pregnancy complications. Journal of Reproductive & Infant
Psychology, 26(2), 74-85.
Wilkinson, A., Anderson, S., & Wheeler, S. B. (2017). Screening for and treatment
postpartum depression and psychosis: a cost-effectiveness analysis. Maternal And
Child Health Journal, 21(4), 903-914.
MAKING MUSIC WITH MOMMY AND ME
PART B
The Guidebook- Making Music with Mommy and Me: A Perinatal
Music Therapy Program
28
Making Music with Mommy and Me
ð
A PERINATAL MUSIC THERAPY PROGRAM
GUIDEBOOK
ALICIA DREXEL, MT-BC
BERKLEE COLLEGE OF MUSIC
MAY 2018
Making Music with Mommy and Me
A Perinatal Music Therapy Program
CONTENTS
Introduction ……………………………………………………………………………...3
Maternal-Infant Attachment ……………………………………………………...3
Bonding Techniques ……………………………………………………………...3
Evaluation Tools ………………………………………………………………….4
Suggestions and Considerations ………………………………………………….5
Qualifications and Training….……………………………………………………5
Session Outline Description Page.………………………………………………..6
Session Outlines
Preliminary Session ………………………………………………………………7
Session 1: Music-making..………………………………………………………..8
Session 2: Creation of bonding song.…………………………………………....10
Session 3: Completion of bonding song.………………………………………...12
Bonding Techniques.…………………………………………………………………...14
Technique 1: Auditory Stimulation
Technique 2: Singing mother’s song of kin
Technique 3: Jingles for everyday tasks
Technique 4: Multimodal Stimulation Instructions…..………………………….15
Options for Songwriting.……………………………………………………………….17
Steps.…………………………………………………………………………….18
List of Suggested Songs………………………………………………………………...20
Evaluation Tools
A: Pre-Questionnaire.…..………………………………………………………..21
B: Maternal-Infant Bonding Scale (MIBS)…………...…………………………23
C: Postpartum Bonding Questionnaire (PBQ).………..………………………...25
D: Post-Questionnaire.……………………..……………………………………26
Postpartum Depression Information.…………………………………………………...28
Postpartum Depression Resources……………………………………………………...29
Edinburgh Postnatal Depression Scale (EPDS)………………………………………...30
Music Therapy Resources………………………………………………………………32
Guidebook References …………………………………………………………………33
2
Making Music with Mommy and Me
A Perinatal Music Therapy Program
INTRODUCTION
Making Music with Mommy and Me is a perinatal music therapy program designed for mothers who
want to connect more with their infants. This program aims to use the technique of songwriting and
taps into the creativity of the mother as a way for her to bond with her baby and form healthy maternalinfant attachments. This guidebook provides music therapists with a pre-questionnaire, assessment
forms, a post-questionnaire, as well as session outlines, list of suggested songs, and options for
songwriting. The session outlines contain a description page for each of the three sessions. For each
session, there are goals/objectives, equipment/materials required, procedure and take-home tips. The
mother will be encouraged to engage with her baby throughout the sessions and will be given various
techniques on ways to bond with her baby. She will be asked to sing and make music with the baby
and therapist. By the end of this three-session program, the mother will have learned techniques to
bond with her baby, and created a bonding song, which she can sing to her newborn baby.
Maternal-Infant Attachments
Attachment is defined as “a close emotional bond between two people” (Santrock, 2008,
p.360). Forming healthy attachments is crucial for infants and a necessary part of their growth and
development. It is both a physical and psychological need of babies that provides comfort and
protection. The mother is typically the first emotional attachment for the child and therefore, will have
an impact on all future attachments the infant develops (Perrelli, 2014). This bond, however, may not
come naturally for the mothers, but is an ongoing process starting during pregnancy and continuing
once the infant is born.
Bonding Techniques
One of the interventions used in this program is the creation of a bonding song through
songwriting. There are four options for creating a bonding song. Those include: lyric substitution,
song recreation, original song writing done by mother and therapist, or original songwriting done by
the therapist. A recording of the special bonding song will be provided for the mother to use and she
will be encouraged to sing this song to the baby, when she wishes to soothe the baby or herself.
3
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Other bonding techniques will also be introduced throughout the three sessions. These include
auditory stimulation (Nocker-Ribaupierre, 2013), singing mother’s song of kin (Loewy, 2000), jingles
for everyday tasks (Hanser, 2016), and a multimodal stimulation technique (Standley, 2010). Auditory
stimulation encourages the mother to speak to her baby, using her voice as a way of telling her baby
she is there and that she loves him/her. The mother may choose to read a book, poem or verse to her
baby, and will be encouraged to create a jingle that provides an intention for her baby. Singing
mother’s songs of kin encourages the mother to sing her own favorite music to her baby, and the
therapist shows her ways to change and alter the song, to be more appropriate to sing to an infant.
These can include changing the tempo, time signature, volume and articulation. Jingles for everyday
tasks include short, affirmative tunes for everyday tasks, such as changing the diaper and clothing,
feeding, washing and playing. The mother will be asked to create her own jingles for each of these
tasks. The multimodal stimulation technique encourages the use of singing with massage and rocking.
There is a progression for the massage that is listed in the guidebook. These techniques developed by
Standley and Loewy that have been used in the NICU and have been adapted to use in this guidebook.
The focus of the techniques in the guidebook is teaching the mother how to implement these
techniques normally done by a music therapist. A description of each technique can be found on page
14 of the guidebook.
Evaluation Tools
The following post- and pre-tests will be administered. These forms can be found in the appendix of
the guidebook.
Pre-Questionnaire
This form will gather basic information from the mother, including background information on
the mother, the mother’s music background and expectations from this program. It will be filled out
during the preliminary session and used during the remaining sessions as a reference.
Mother-Infant Bonding Scale (MIBS)
The MIBS consists of eight adjectives divided into three aspects: positive, negative and
confused attachment. High scores indicate problems in the mother-infant bonding (Perrelli, 2014).
This scale is used as a pretest and posttest to evaluate changes in mother-infant bonding
4
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Postpartum Bonding Questionnaire (PBQ)
The PBQ, a 25-ietm self-report questionnaire, aims to identify problems in the mother-baby
relationship based on four components: 1) weakened bonding, 2) rejection and pathological rage, 3)
anxiety about the baby/anxiety about caring for the baby, and 4) imminent abuse/risk of abuse
(Brokington et al., 2001). This scale will also be used as a pretest and posttest to assess mother-infant
bonding.
Post-Questionnaire
This form will be filled out after completion of the program and recording of the bonding song.
It contains five wrap-up questions evaluating the mother’s experience with the program. It will be
completed at the end of the third session.
Suggestions and Considerations
The guidebook is designed for individual music therapy sessions, as this process is an intimate
experience shared between the mother and baby, facilitated by the music therapist. This program
should be implemented in a quiet space where the music therapist can meet with the mother. The
mother will be invited and encouraged to bring her baby along to the sessions.
This guidebook may also be adapted and used with other caregivers including fathers,
grandparents, older siblings, and any other caregiver. The author does, however, stress the importance
of the maternal-infant relationship, as explained in the introduction.
Qualifications and Training
A music therapist, who has completed a degree program in music therapy and passed the music
therapy board exam administered by the Certification Board for Music Therapists, is qualified to
implement this guidebook. Specialized training in NICU music therapy is recommended, but not
required. It is also recommended that the therapist have additional training in the area of perinatal
music therapy and those without should seek supervision from an experienced board certified music
therapist. A list of books and resources if found at the end of this guidebook (page 32).
5
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session Outline Description Page
Goals/objectives
Each session has goals/objectives. The statements all begin with “Mother will…” and provide the
therapist with a clear idea of the purpose of the session. There is a preliminary session followed by
session 1: music-making, session 2: creation of bonding song and session 3: completion of bonding
song.
Equipment/materials
The required equipment and materials will be listed. Items will include the forms, instruments, and
recording equipment. All forms can be found in the appendix.
Procedure
This section contains a list of steps to take in each session, including bonding techniques for the
mother to engage with her baby. The section is presented in a step-by-step fashion; however it does
not need to be completed in the numerical order presented on the description page.
Take-home tips
This section includes suggested tasks for the mother to complete during the week to foster bonding
with her baby. The therapist will guide the mother during the session and then ask the mother to try
these on her own. At the beginning of the next session, these will be addressed and checked to see
how the mother has implemented the take-home tips that week.
6
Making Music with Mommy and Me
A Perinatal Music Therapy Program
SESSION OUTLINES
Preliminary Session
Goals/objectives
Mother will understand the songwriting process and purpose for the intervention
Mother will complete the pre-questionnaire, MIBS and PBQ
Mother will be introduced to the options for songwriting
Equipment/materials
Pre-Questionnaire (evaluation form A)
MIBS (evaluation form B)
PBQ form (evaluation form C)
Procedure:
1. Explain that this is a three-session program and during each session, the mother will be given
various bonding techniques to use with her baby. She will also be creating her own bonding
song with the music therapist. At the end of each session, there will be take-home tips that are
mini-tasks for the mother to try during the week before the next session. These techniques and
the bonding song are ways to promote healthy attachments and improve bonding with her baby.
Explain that it is necessary for the baby to be present so the music therapist can demonstrate the
various techniques during each session.
2. Allow mother to fill out each form (pre-questionnaire, MIBS and PBQ) and collect assessments
for scoring. See evaluation forms for scoring of each assessment form.
3. Provide mother with the options for songwriting and explain each option, giving her an
overview of what is to come.
4. Answer any questions she may have, and make a plan for future sessions (when & where).
7
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session 1: Music-making
Goals/objectives:
Mother will explore her music interests and be shown how she can present those to her baby
Mother will learn two techniques to engage with her baby
Mother will choose the option for songwriting
Equipment/materials
Completed forms
Pre-Questionnaire (for reference)
Music for songs/bands/genres mother indicated on her intake form
Guitar for live music and/or device to play recorded music
Procedure
1. Begin by encouraging the mother to hold her baby and talk to him/her. Explain that the
mother’s voice is the most familiar sound to the baby and encourage this interaction by
developing some mantras (examples can be found in the Take-Home Tips section).
2. Discuss answers on Pre-Questionnaire, focusing on the Music Background section. When
discussing mother’s preferred music, sing one of her favorite songs. If the mother or therapist
is uncertain of the words, show the mother where she can find them, and then sing the song
together. Discuss the meaning and/or significance this song has for the mother.
3. Encourage the mother to sing this song to her baby. This song has great meaning for the
mother and she should feel comfortable with sharing this part of her with her baby. Together
think of ways that the song could be adapted to sing to her baby: slowing down the tempo or
elongating the phrases; changing the time signature to 3/4; changing the dynamics or
articulation. Remind mother that babies are sensitive to new stimulation, but encourage them
to use her own voice to talk and sing to her baby. Her baby could hear her voice already while
in the womb and therefore is the most familiar sound he/she knows.
4. At the conclusion of the session, review the options for songwriting and have the mother decide
which one she would like to work on during the next session.
8
Making Music with Mommy and Me
A Perinatal Music Therapy Program
5. End the session by providing the mother with the Take-Home Tips.
Take-Home Tips
1. Encourage mother to sing her favorite song to her baby throughout the week and ask her to find
a lullaby that she could also sing to her baby
2. Ask mother to write down a jingle as an affirmative intention for her baby. Examples of a
mantra include: “I love you” “You are my everything”
9
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session 2: Creation of bonding song
Goals/objectives
Mother will learn two new techniques to engage with her baby
Mother will develop the bonding song
Equipment/materials
Guitar for live music and/or device to play recorded music
Notepad or recording device to use during song writing process
Print out of the Multimodal Stimulation Technique
Procedure
1. Begin the session by reviewing the Take-Home Tips from session 1 and check-in to see how
they went. Review the two techniques from session 1 and have the mother sing her favorite
song to her baby. Ask the mother what jingles she created and encourage her to sing/say these
to her baby.
2. Discuss different times she can sing to her baby, for example when changing the diaper and
clothing, when feeding, when washing and when playing. Create little jingles for each of these
tasks and any other tasks the mother suggests.
3. Demonstrate to the mother how touch can have a positive effect on the baby too. Multimodal
stimulation can help the baby tolerate and process different kinds of stimulation. This
stimulation begins with singing and then goes through massaging different parts of the baby’s
body. Steps for this technique can be found on the Multimodal Stimulation Instructions page
(page 15). Encourage the mother to try this process during the session and point out moments
of over stimulation. Provide the mother with a handout of the instruction page for her to try at
home.
4. Review the option the mother selected for songwriting. Begin the steps listed on pages 18-19.
5. End the session by reflecting on the songwriting process, and provide the mother with the
Take-Home Tips.
10
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Take-Home Tips
1. Encourage mother to use the jingles created
2. Provide the mother with a handout of the Multimodal Stimulation techniques and ask her to try
them at home
3. Encourage mother to sing part of the bonding song that was created during session 2 to her
baby throughout the week
11
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Session 3: Completion of bonding song
Goals/objectives
Mother will complete the bonding song
Mother will create art for cover of CD
Mother will complete Post-Questionnaire, MIBS, and PBQ
Equipment/materials
Post-Questionnaire (evaluation form D)
MIBS (evaluation form B)
PBQ (evaluation form C)
Instruments (i.e. guitar, piano, ocean disc, etc)
Recording equipment (e.g., laptop with garage band app and CD port, microphone, speakers)
Blank CD and cover
Coloring materials for CD cover art
Procedure
1. Begin the session by reviewing the Take-Home Tips from session 2 and check-in to see how
they went. Review the two techniques from session 2 and have the mother share any new
jingles she created. Encourage mother to try the Multimodal Stimulation technique again and
check-in to see how she is doing.
2. If the bonding song was not completed during session 2, finish the necessary steps to complete
the song. Once completed, encourage the mother to sing the new song to her baby. If she
desires, you may record the song, which she can then play for her baby. Remind the mother
that the optimal experience is for her to sing live to her baby. While the CD is being burned,
have mother create artwork for the CD cover as another expressive outlet.
3. Allow mother to fill out post-questionnaire, MIBS and PBQ and discuss answers to the
questionnaire.
4. Review the four techniques and remind the mother that she has all the tools now to interact and
engage with her child in a positive, creative way. Encourage her to continue to use the jingles
12
Making Music with Mommy and Me
A Perinatal Music Therapy Program
that were created and, of course, sing the bonding song. Ask mother if she feels comfortable
creating and singing new songs and jingles.
13
Making Music with Mommy and Me
A Perinatal Music Therapy Program
BONDING TECHNIQUES
Technique 1: Auditory Stimulation
This technique encourages the mother to speak to her baby, using her voice as a way of telling her
baby she is there and that she loves him/her. The mother may choose to read a book, poem or verse to
her baby and will be encouraged to create a jingle as a positive affirmation for her baby.
Technique 2: Singing mother’s song of kin
For this technique, the therapist encourages the mother to sing her own favorite music to her baby. And
shows her ways to change and alter the song to be more appropriate to sing to an infant. These can
include changing the tempo, time signature, volume and articulation.
Technique 3: Jingles for everyday tasks
This technique encourages mother to create little jingles for everyday tasks such as changing the diaper
and clothing, feeding, washing and playing. The mother will be asked to create her own jingles for
each of these tasks.
Technique 4: Multimodal Stimulation
This last technique encourages the use of singing with massage and rocking. A progression of
massages is listed on the following page with instructions on how to implement this technique.
14
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Technique 4: Multimodal Stimulation Instructions
Sit down in a rocking chair with the baby comfortably in your arms. Sit still, not rocking and begin
when the baby is calm. Do each step for about 30 seconds. If at any time the baby shows signs of
over-stimulation (listed on the following page), stop and wait until the baby is calm again.
1. Sing only
2. Sing and massage
a. head – in a line on the sides and back of head
b. back- in a line from neck to bottom
c. back – in a big circle over the entire back
d. neck – in a line on the sides and throat area
e. arms – in a line or circle
f. chest and belly – in a line from neck to belly button
g. legs – in a line or circle
h. cheeks – in a line from eye to jaw
i. forehead – in a line from left to right or right to left
j. nose to ear – in a line
3. Sing and rock – in slow, steady, rocking motion
4. Sing, rock and massage
a. head – in a line on the sides and back of head
b. back- in a line from neck to bottom
c. back – in a big circle over the entire back
d. neck – in a line on the sides and throat area
e. arms – in a line or circle
f. chest and belly – in a line from neck to belly button
g. legs – in a line or circle
h. cheeks – in a line from eye to jaw
i. forehead – in a line from left to right or right to left
j. nose to ear – in a line
15
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Common signs of overstimulation
•
“Stop” hand - this looks like the baby is saying, “stop” or “wait” with his/her hand. The palm
is facing out toward you
•
Grimace/red face - the baby looks like he/she is about to cry or is uncomfortable, or the baby’s
face suddenly gets red or reddish-purple
•
Crying
•
Startle reflex - the baby’s whole body jerks
•
Tense fingers - the baby spreads his fingers out and the fingers are stiff or tense
•
Arched back - when the baby’s back bends backward and the belly is pushed forward, as if the
baby is trying to get away from what is in front of him/her
•
Hiccups – while they may not be the sign of over-stimulation, it can be stressful and it is best to
wait for them to pass before continuing with any stimulation
Common positive responses
•
Faces you – the baby’s head and face is turned toward you, looks like the baby is looking at
you, even though baby’s eyes may be closed
•
Eye contact – the baby’s eyes look at your eyes
•
Smiling – the baby smiles even if asleep
•
Vocalization – the baby uses his/her voice by cooing, “talking”, sighing, etc.
•
Snuggling – the baby gets closer to you or settles into your arms.
Tips for infant massage
•
Use two or three fingers for massage, and a firm but gentle stroke.
•
The touch should be firm enough so the baby will feel massaged, but not so firm that it would
hurt the baby.
•
Use enough pressure that it doesn’t tickle the baby’s skin, because that may be upsetting.
•
Your stroke/massage should probably move the baby’s skin a little beneath your fingers.
16
Making Music with Mommy and Me
A Perinatal Music Therapy Program
OPTIONS FOR SONGWRITING
When it comes time to begin working on the bonding song, use this page as a guide to decide which
songwriting option the mother will work on. Each option is described and benefits of each are listed.
For songs suggestions please refer to the List of Suggested Songs on page 20.
Option 1: Lyric Substitution
A familiar song is used leaving some words out which the mother then fills in with her own lyrics.
This method provides more structure for the mother and is ideal for those weary of songwriting.
Option 2: Song Recreation
Uses the music of a familiar song, but creates new lyrics or uses lyrics of familiar song and creates
music. Also the mother may bring in a poem, verse, or quote which she then sets to music.
Option 3: Original Song
(by mother and therapist)
The mother creates both the music and the lyrics with the assistance of the music therapist. Music
therapist may provide themes for lyrics and music and guides the mother to make decisions.
Option 4: Original Song
(by the therapist)
The mother may discuss the lyrics with the therapist, but ultimately the therapist is the one to construct
them as a song, also adding the music.
17
Making Music with Mommy and Me
A Perinatal Music Therapy Program
OPTIONS FOR SONGWRITING
Steps
Option 1: Lyric Substitution
STEP1: Select the song to be used. See the List of Suggested Songs for ideas or use a song from the
mother’s interests.
STEP 2: Sing the selected song and then decide which words you will keep/replace.
STEP 3: Fill in the blank spaces to complete the song.
STEP 4: Sing new song and make necessary changes.
STEP 5: Give a title to the new song.
Option 2: Song Recreation
STEP 1: Select the song to be used. See the List of Suggested Songs for ideas or use a song from the
mother’s interests. *If the mother chooses to bring in a poem, verse or quote, begin by reading and
discussing the meaning and impact it has for the mother.
STEP 2: Sing the song and then decide if you are going to keep the words or the melody.
STEP 3: If keeping the lyrics, begin discussing new melodies or motifs to use. If keeping the melody
discus themes to begin creating new lyrics.
STEP 4: Formulate the new melody or new lyrics, add with the old lyrics or old melody, and sing new
song.
STEP 5: Give a title to the new song.
18
Making Music with Mommy and Me
A Perinatal Music Therapy Program
Option 3: Original Song
(by mother and therapist)
STEP 1: Begin by discussing themes for the bonding song and keep notes of the ideas developed.
STEP 2a: Using the theme, develop a chorus or hook for the song.
STEP 2b: Using the other ideas discussed, develop the verses for the song.
STEP 3: Develop the melody for the chorus and verses and decide on accompaniment style and the
instruments to use.
STEP 4: Sing the song and make necessary changes.
STEP 5: Give a title to the new song.
* steps 2a/2b and step 3 may switch if the mother chooses to begin by creating a melody and then
adding lyrics second.
Option 4: Original Song
(by the therapist)
STEP 1: Begin by discussing themes for the bonding song and keep notes of the ideas developed.
STEP 2: Take the ideas and create the verse and chorus of the song as well as the melody,
accompaniment style and instrumentation. Discuss all of these elements, however, the music therapist
is the one creating them.
STEP 3: Bring the created song to the mother and discuss any changes
STEP 4: Sing the song and make necessary changes.
STEP 5: Give a title to the new song.
19
Making Music with Mommy and Me
A Perinatal Music Therapy Program
LIST OF SUGGESTED SONGS
Below is a list of suggested songs in alphabetical order. These songs should be used for option 1 and
option 2 of the Options of Songwriting. For a description of the options, please see page 17.
A Dream is a Wish Your Heart Makes- Cinderella
Kumbaya
All I Have to Do Is Dream- The Everly Brothers
Little Boy Blue
Cradle Song
Little Bo Peep
Amazing Grace
Mary Had A Little Lamb
Angel- Sarah McLachlan
Moon Shadow- Cat Stevens
Baby Mine- Dumbo
My Bonnie Lies Over the Ocean
Blackbird- The Beetles
My Favorite Things- Sound of Music
Danny Boy
Once Upon a Dream
German Cradle Song
Rock a Bye Baby
Goodnight, My Angel- Billy Joel
Somewhere Over the Rainbow- Israel
He’s Got the Whole World
Kamakawiwo’ole
Here Come the Sun- The Beatles
Sounds of Silence- Simon & Garfunkel
Hush Little Baby
Swing Low Sweet Chariot
I Want to Hold Your Hand- The Beatles
Too Ra Loo Ra Loo Ral- Bing Crosby
The Itsy Bitsy Spider
Twinkle, Twinkle Little Star
Jesus Loves Me
You Are My Sunshine
Just the Way You Are- Billy Joel
When You Wish Upon a Star
20
Making Music with Mommy and Me
Pre-Questionnaire
A Perinatal Music Therapy Program
GENERAL INFORMATION
Mother’s Name: ____________________________________________
Phone number: ____________________
DOB: _________________
Email address: __________________________________
Child’s Name: _____________________________________________
DOB: _________________
Siblings: __ yes __ no if yes, how old ___________________________________________________
MUSIC BACKGROUND
What is the typical role of music in your life? (check all that apply)
__ I listen to music in the car or at home
__ I like to sing, but only in the shower
__ I have musical instruments sitting around and dabble with them here and there
__ I play a musical instrument
if yes, what do you play ________________________________________________________
__ I make music with other people sometimes/often (please circle)
__ I turn to music when I am going through a hard time or feeling bad
__ Other __________________________________________________________________________
What genre of music do you enjoy: (check all that apply)
__ Alternative Rock
__ Blues
__ Chant
__ Classical
__ Country
__ Death metal
__ Disco
__ Folk music
__ Funk
__ Heavy metal
__ Hip Hop
__ Indie rock
__ Jazz
__ Musical theatre
__ Opera
__ Pop music
__ Punk rock
__ Rap
__ Reggae
__ Rhythm and blues
__ Rock and Roll
__ Soul/Gospel
__ Spiritual
__ Techno
What radio stations, songs, or artists do you usually listen to?
__________________________________________________________________________________
Songwriting
Have you ever written a song?
Have you ever written a poem?
__ yes __ no
__ yes __ no
Comfort level on song writing
comfortable
(1) very
(2) some what
uncomfortable
(3) neutral
(4) some what
(5) very
21
Making Music with Mommy and Me
Pre-Questionnaire
A Perinatal Music Therapy Program
What are your expectations/wishes for this program?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Any other information the music therapist should know?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________
Mother’s Name: ________________________
Administered by: _______________________
Date: _____________
22
Making Music with Mommy and Me
Perinatal Music Therapy Program
Maternal-Infant
Bonding Scale
MATERNAL-INFANT BONDING SCALE
These questions are about your feelings for your child in the first few weeks. Some adjectives are listed
below which describe some of the feelings mothers have towards their baby in the first weeks after they
were born. Please make a tick against each word in the box, which, best describes how you felt in the first
few weeks.
VERY MUCH
A LOT
A LITTLE
NOT AT ALL
Loving
Resentful
Neutral or felt
nothing
Joyful
Dislike
Protective
Disappointed
Aggressive
Mother’s Name: _____________________________
Score: ____________
Administered by: ____________________________
Date: _____________
23
Making Music with Mommy and Me
Perinatal Music Therapy Program
Maternal-Infant
Bonding Scale
SCORING
VERY MUCH
A LOT
A LITTLE
NOT AT ALL
Loving
0
1
2
3
Resentful
3
2
1
0
Neutral or felt
nothing
3
2
1
0
Joyful
0
1
2
3
Dislike
3
2
1
0
Protective
0
1
2
3
Disappointed
3
2
1
0
Aggressive
3
2
1
0
24
Making Music with Mommy and Me
Postpartum Bonding
Questionnaire
A Perinatal Music Therapy Program
POSTPARTUM BONDING QUESTIONNAIRE
Please indicate how often the following are true for you. There are no “right” or “wrong” answers. Choose
the answer that seems right in your recent experience.
Always
Very
often
Quiet
often
Sometimes
Rarely
Never
I feel close to my baby
I wish the old days when I had no baby would come back
I feel distant from my baby
I love to cuddle my baby
I regret having this baby
The baby does not seem to be mine
My baby winds me up
My baby irritates me
I feel happy when my baby smiles or laughs
I enjoy playing with my baby
My baby cries too much
I feel trapped as a mother
I resent my baby
My baby is the most beautiful baby in the world
I wish my baby would somehow go away
I have done harmful things to my baby
My baby makes me anxious
I am afraid of my baby
My baby annoys me
I feel confident when changing my baby
I feel the only solution is for someone else to look after my baby
I feel like hurting my baby
My baby is easily comforted
Mother’s Name: __________________________
Administered by: __________________________
Date: _____________
25
Making Music with Mommy and Me
Post- Questionnaire
A Perinatal Music Therapy Program
GENERAL INFORMATION
Mother’s Name: ____________________________________________
Phone number: ____________________
DOB: _________________
Email address: __________________________________
QUESTIONNAIRE
Please answer the following questions based on your experience during “Making Music with Mommy
and Me.”
1. Now that you have completed the bonding song, how comfortable do you feel about songwriting?
comfortable
(1) very
uncomfortable
(2) some what
(3) neutral
(4) some what
(5) very
2. Did you enjoy creating the bonding song?
yes
no
Explain: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3. Have you implemented any of the four bonding techniques?
yes
no
Which one(s): ______________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4. Do you feel closer to your baby after completing “Making Music with Mommy and Me”?
yes
no
Explain: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
26
Making Music with Mommy and Me
Post-Questionnaire
A Perinatal Music Therapy Program
5. Were your expectations of “Making Music with Mommy and Me” met?
yes
no
Explain: ___________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Mother’s Name: ________________________
Administered by: _______________________
Date: _____________
27
Making Music with Mommy and Me
Perinatal Music Therapy Program
POSTPARTUM DEPRESSION INFORMATION
Postpartum depression affects up to 1 in 7 women, according to the American Psychological
Association (Postpartum Depression, n.d.). The DSM-V recognized that anxiety and depression may
occur both during and after pregnancy and has revised the once called major depressive disorder with
postpartum onset to major depressive disorder with perinatal onset (Wenzel & Kleiman, 2015).
Postpartum anxiety and depression can take on various forms including generalized anxiety, panic
attacks, social anxiety, obsessions and compulsions, and posttraumatic stress. While there are risk
factors any mother may experience these symptoms.
Music therapists who implement this program may come across mothers who are showing
signs and symptoms of postpartum depression. Below is information and resources to provide mothers
with, who may be experiencing post-partum depression. While music therapist are not qualified to
diagnosis postpartum depression they are ethical responsible to provide the necessary resources for the
mother.
The Edinburgh Postnatal Depression Scale (EPDS) can be used as a resource as well (see
page 30).
Symptoms may include:
•
Feelings of anger or irritability
•
Lack of interest in the baby
•
Appetite and sleep disturbance
•
Crying and sadness
•
Feelings of guilt, shame or hopelessness
•
Loss of interest, joy or pleasure in things they used to enjoy
•
Difficulty bonding with her baby
•
Feeling regret for having a baby
•
Possible thoughts of harming the baby or themselves
28
Making Music with Mommy and Me
Perinatal Music Therapy Program
POSTPARTUM DEPRESSION RESOURCES
Postpartum Support International supports all pregnant, postpartum, and post-loss
families through regional, state, and national support coordinators; telephone hotlines;
chats; forums; and groups. http://www.postpartum.net
2020 Mom engages advocates in maternal mental healthcare to drive change in their
communities and states. They’re on a mission to close gaps in care through education,
advocacy, and collaboration. https://www.2020mom.org
Postpartumprogress.com is the world’s most widely read blog dedicated to maternal
mental illness. It offers warm, positive, in-depth information, support and hope for all
pregnant and new moms who experience postpartum depression and all other mental
illnesses related to pregnancy and childbirth, including postpartum anxiety,
postpartum OCD, depression or anxiety during pregnancy, post-adoption depression,
postpartum PTSD, bipolar, peripartum onset/postpartum bipolar, depression after miscarriage or
perinatal loss and postpartum psychosis. A list of support groups in each state can be found on this
page http://www.postpartumprogress.com/postpartum-depression-support-organizations-in-the-uscanada-uk-south-africa-australia-new-zealand
Edinburgh Postnatal Depression Scale (EPDS)
The EPDS is a 10-ietm self-repot scale used to screen for postnatal depression. Each question
is scored; mothers who score higher than 10 are likely to be suffering from depression (Cox, Holden,
Sagvosky, 1987).
29
Making Music with Mommy and Me
Perinatal Music Therapy Program
EDINBURCH POSTNATAL DEPRESSION SCALE (EPDS)
Please check the answer that comes closest to how you have felt in the past 7 days, not just how you
feel today.
Here is an example, already completed.
I have felt happy:
Yes, all the time
Yes, most of the time
No, not very often
No, not at all
In the past 7 days:
1.
I have been able to laugh and see the funny side of things
As much as I always could
Not quite so much now
Definitely not so much now
Not at all
2.
I have looked forward with enjoyment to things
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
3.
4.
5.
I have blamed myself unnecessarily when things went wrong
Yes, most of the time
Yes, some of the time
Not very often
No never
I have been anxious or worried for no good reason
No, not at all
Hardly ever
Yes, sometimes
Yes, very often
I have felt scared or panicky for no very good reason
Yes, quite a lot
Yes, sometimes
No, not much
No, not at all
6.
Things have been getting on top of me
Yes, most of the time I haven’t been able to cope
at all
Yes, sometimes I haven’t been coping as well as
usual
No, most of the time I have coped quite well
No, I have been coping as well as ever
7.
I have been so unhappy that I have had difficulty
sleeping
Yes, most of the time
Yes, sometimes
Not very often
No, not at all
8.
I have felt sad or miserable
Yes, most of the time
Yes, quite often
Not very often
No, not at all
9.
I have been so unhappy that I have been crying
Yes, most of the time
Yes, quite often
Only occasionally
No, never
10. The thought of harming myself has occurred to me
Yes, quite often
Sometimes
Hardly ever
Never
Mother’s Name: _____________________________
Score: _____________
Administered by: ____________________________
Date: ___________
30
Making Music with Mommy and Me
Perinatal Music Therapy Program
INSTRUCTIONS AND SCORING
Instructions
1. The mother is asked to check the response that comes closet to how she has been feeling in the
previous 7 days
2. All the items must be completed
3. Care should be taken to avoid the possibility of the mother discussing her answers with others
(answers come from the mother or pregnant woman)
4. The mother should complete the scale herself, unless she has limited English or has difficulty
with reading
Scoring
Questions 1, 2 & 4
Are scored 0, 1, 2 or 3 with top box scored as 0 and the bottom box scored as 3
Questions 3, 5-10
Are reverse scored, with the top box scored as a 3 and the bottom box scored as 0
Maximum score:
30
Possible Depression:
10 or greater
*Always look at item 10 (suicidal thoughts)
31
Making Music with Mommy and Me
Perinatal Music Therapy Program
MUSIC THERAPY RESOURCES
Books
1. Music Therapy and Parent Infant Bonding edited by Jane Edwards
2. Music Therapy in Neonatal Intensive Care Unit by Joanne Loewy
3. Music Therapy with Premature Infancts by Jayne Standley and Darcy Walworth
4. Songwriting: Methods, Techniques and Clinical Application for Music Therapy Clinicians,
Educators and Students by Felicity Baker and Tony Wigram
5. Integrative Health Through Music Therapy Accampanying the Journey from Illness to
Wellness by Suzanne Hanser
6. Cognitive Behavior Therapy for Perinatal Distress by Amy Wenzel and Karen Kleiman
32
Making Music with Mommy and Me
Perinatal Music Therapy Program
GUIDEBOOK REFERENCES
Brockington, I. F., Oates, J., George, S., Turner, D., Vostanis, P., Sullivan, M., & ...
Murdoch, C. (2001). A Screening Questionnaire for mother-infant bonding disorders. Archives
Of Women's Mental Health, 3(4), 133-140.
Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh
Postnatal Depression Scale (EPDS). London, England: Royal College of Psychiatrists
Hanser, S. B. (2016). Integrative health through music therapy accompanying the
journey from illness to wellness. United Kingdom: Palgrave Macmillan.
Loewy, J. (2000) Music therapy in neonatal care unit. New York: Satchnote Press
Nocker-Ribaupierre, M.(2013). Premature infants. In Bradt, J. (Ed.), Guidelines for music therapy
practice in pediatric care (66-115). Gilsum, NH: Barcelona Publishers
Perrelli, J. A., Zambaldi, C.F., Cantilino, A., & Sougey, E. B. (2014). Mother-child bonding
assessment tools. Revista Paulista De Pediatria: Orgao Oficial Da Sociedade De Pediatria De
Sao Paulo, 32(3), 257-265.
Postpartum Depression. (n.d.) In American Psychological Association online. Retrieved
from
http://www.apa.org/pi/women/resources/reports/postpartum-depression.aspx
Santrock, J., W. (2008). A topical approach to life-span development. New York, New
York: MGraw-Hill.
Standley, J. M., Walworth, D. (2010). Music therapy with premature infants. Silver
Spring, Maryland: American Music Therapy Association, Inc.
Wenzel, A., Kleiman, K., (2015). Cognitive behavioral therapy for perinatal distress.
New York, New York: Routledge Taylor and Francis Group.
33
Making Music with Mommy and Me
Perinatal Music Therapy Program
34
Media of
